Inspection on 12/01/09 for Avon Lodge Care Centre

This inspection was carried out on 12th January 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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Avon Lodge Care Centre 16/09/09

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Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avon Lodge Care Centre Southey Avenue Kingswood Bristol BS15 1QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Garrett     Date: 1 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Avon Lodge Care Centre Southey Avenue Kingswood Bristol BS15 1QT 01179474370 01179474377 avonlodge@lifestylecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Life Style Care (2005) Plc care home 62 Number of places (if applicable): Under 65 Over 65 0 20 dementia old age, not falling within any other category Additional conditions: 42 0 The maximum number of service users who can be accommodated is 62. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) maximum of 42 places Old age, not falling within any other category (Code OP) maximum of 20 places Date of last inspection Brief description of the care home Avon Lodge Care Centre was registered in July 2008. Its owned and run by Life Style Care plc that has been established for over twenty years. The company has many homes nationwide and has lots of experience in running care homes for people with dementia. The aim of the home is to provide a high quality service based on principles of person-centred care, respecting individual choice and dignity. Avon Lodge is located in an area close to Kingswood High street. It can accommodate sixty-two people. Forty-two will have a diagnosis of dementia and the remaining twenty will need general nursing care. The home is set out over three floors. The ground floor is for Care Homes for Older People Page 4 of 36 Brief description of the care home nursing care and the two upper floors for people with dementia. Each bedroom has its own en-suite toilet and washing facilities. In addition there are several well appointed bathrooms with the most up to date bathing equipment. Other facilities include dining rooms, activity rooms, a hairdressing room and a snoozelen (a specialised relaxation room to help people with dementia). It should be noted that Life Style Care operates a no smoking policy in each of their new homes. This means that people who smoke will only be able to do so outside of the building. This information is included in the Statement of Purpose. Fees payable are between £550 (as a baseline for nursing care) and £580 pounds (for dementia care). Exact amounts payable are worked out following the assessment of need and whether people are entitled to help with nursing or continuing care contributions. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk /www.oft.gov.uk Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit, all information the Commission for Social Care Inspection (the Commission) has received about the service since registration was looked at. We then drew up an inspection record in preparation for the visit. This record is used to focus on and plan all inspections so that we concentrate on checking the most important areas. Because people with dementia arent always able to tell us about their lives, we use a formal way of observing them to help us understand better. We call it the: Short Observational Framework for Inspection (SOFI). This means using a methodical and structured way of watching people living at the home. We did this for 2 hours in a lounge and dining room and recorded peoples experiences at frequent intervals. It included looking at their wellbeing, how they interacted with, other people living at the Care Homes for Older People Page 6 of 36 home, staff members and the environment. We also saw how other people live their lives at the home. Information from the observation is included throughout this report. We spoke to people living at the home, two sets of relatives and several staff. Staff also filled in Have Your Say questionnaires that we gave them and comments are included throughout this report. What the care home does well: What has improved since the last inspection? What they could do better: No legal requirements were made at this visit. We concluded that the home meets the National Minimum Standards and that people are cared for properly and kept safe. However, we made a number of good practice recommendations that should be taken seriously. These included: making sure information is physically accessible, (including the service users guide and complaints information) for both people with sight difficulties and those with dementia. Clear information about fees should be available for relatives or representatives in the service users guide, so that they are aware of potential costs from the outset. Further recommendations included: making care plans more person-centred, (putting people at at the heart of the plan and valuing them as individuals not just meeting their healthcare needs). Care plans should also show that people are involved or consulted about their care needs where possible. The manager should also make sure that all staff get supervision at regular intervals so that people are cared for by staff that have opportunities to reflect on their work and are subject to regular checks with senior staff. Care Homes for Older People Page 8 of 36 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people benefit from being given clear information about the home when they come into it, the information isnt fully accessible to people with sight difficulties or dementia that may put them at a disadvantage. People living at the home or their relatives arent made aware clearly enough about the amount of money they have to pay for living there. Clear and detailed pre-admission assessments make sure that the centre is the right place for people using the service and that staff are able to meet their needs. Suitably trained and experienced staff make sure peoples specialist needs are picked up and met where possible. Care Homes for Older People Page 11 of 36 Evidence: This was the first inspection of Avon Lodge Care Centre since its registration in July 2008. At the visit only two floors were in operation, the ground floor for people with nursing care needs and the first floor for people with dementia care nursing needs. The second floor was due to open the week following this visit. Thirty one people were living at the home (which can house a total of sixty two people) at the time of this visit. We looked at the homes Statement of Purpose, Service User Guide, preadmission assessments, and staff training records.The certificate of registration was on display. The Statement of Purpose (the Statement) is detailed but there was no information about the full fee payable. It states that fees will be discussed when a decision has been made for the person to come to the home. However, there was a lot of information in the Statement about type of fees, who pays what e.g. by social services, nursing and continuing care contributions etc. Fees payable werent mentioned in the service users guide (the guide). We saw blank copies of contracts. These showed that the amount of weekly fee to be paid is filled in when its signed. Both the Statement and the guide were detailed. They give lots of information about the home, management, staff qualifications, complaints, activities etc. The Statement includes information about respecting privacy and dignity, including respect for each persons personal background, culture and lifestyle choices. It also includes information about the meeting of religious needs. However, clear information wasnt seen about how the organisation promotes equality and diversity (this means making sure people from groups that may face discrimination on grounds of e.g. sex, race, religion,disability or age are able to feel comfortable and have their specialist needs met). Further, the guide isnt accessible to people with sight difficulties or people with dementia. The font used and size of type is small and didnt make it easy to read. As the guide gives lots of information about the home and what people can expect, it should be made as accessible as possible e.g. by use of pictures so that people with dementia have an opportunity to understand more about where they are living. Pre- admission assessments are done by the home manager or her deputy. Detailed sheets were seen that showed time had been spent with the person observing their needs and finding out about their health, care needs and background. The assessments had usually been done in hospital before admission to the home. The assessments we looked at showed that information gained about the person had been transferred into care plans that are drawn up during peoples first few weeks at the home. Care Homes for Older People Page 12 of 36 Evidence: People can come and visit before coming into the home although so far most have come straight from hospital or other care homes. They can come and have lunch and spend a few hours if they wish. Information about trial visits is also included in the Statement of Purpose. Relatives do visit and those we spoke to told us they had been able to come and look round before their relative was admitted. This had helped them and all those we spoke to said they were very happy with the choice of home. Staff at the home have a range of experience, expertise and qualifications. There are lead nurses on each floor as well as other trained nurses, senior care assistants and care assistants. All are currently being given dementia care training and more is planned.Staff are also given training in person-centred care. Staff spoken to at this visit were keen to have more training so that they would be able to understand and better meet the needs of people with dementia. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans that dont reflect the person-centred approach being used by staff at the home, fail to show how people are consulted about their care. People living at the home are looked after well in respect of health and personal care needs. Secure management ensures people living at the home are looked after well in respect of medication needs. Being treated with dignity and respect benefits people living at the home. End of life plans arent always developed and put in place to ensure peoples individual wishes are recorded and respected. Evidence: We case-tracked four peoples experience of living at the home. Case tracking is a way Care Homes for Older People Page 14 of 36 Evidence: of thoroughly checking all the information about a sample of people living at the home. That way we can assess whether the care given overall is satisfactory and meets peoples needs. Care plans were very detailed and gave lots of information about peoples care needs that were taken from their original assessments. We looked at plans that showed personal care needs of someone with a life-threatening illness as well as people with behaviours that challenge staff. Each plan was very detailed and gave lots of information about individual needs. However not all parts of the plans were filled in for each person. The person with the life-threatening illness didnt have the advanced care plan filled in to show what care s/he will need at the end of her/his life. However, other people did have this plan filled in. Each person had a nutritional assessment in place that showed actions to be taken to help maintain a proper diet and weight. Risk asssessments for moving and handling, falls and pressure area care were also in place. Information about peoples life histories and preferences were patchy: some were well filled in that gave a clear picture of the person and who s/he had been in her/his former life, though others had less information. The manager showed us one persons life book with photos and information about her life that staff can read with her. This is good practice as it helps people remember their lives and also gives staff lots of information that will help them understand and care for them better. Care plans were written in a very medicalised way. This means that all needs and actions were recorded in ways that were more about their health conditions and actions for staff to take to meet their needs. The manager works from a clear personcentred perspective and staff have been trained in this approach, which is key to good care of people with dementia. However care plans didnt reflect this at all. The manager and operations manager (who visits the home regularly and does internal audits of care), both agreed and said they would be taking action to improve them. Currently the plans dont show that people are consulted or involved with planning their care, or whether their wishes and feelings are taken into account. An example of this was about a persons desire to smoke. All the recorded actions pointed to a more negative approach. This showed no record of discussions held with the person over use of nicotine patches and the person had to ask to have a cigarette, rather than using a more positive, person-centred way of helping her/him enjoy smoking as a pleasurable activity. However we were able to see that in fact people get good results from the actions set out in the plans and one relative we spoke with was keen to tell us how a person had blossomed since coming to the home. Therefore the emphasis is more on the way plans are written rather than the content of them. Care Homes for Older People Page 15 of 36 Evidence: Care plans are looked at monthly and any changes noted. This information is then passed to care staff. As the home has recently opened formal care plan reviews havent taken place yet. However, records showed peoples relatives are consulted about any changes needed. Daily records also werent written in person-centred ways. Whilst it was easy to see that peoples needs were being met, the records didnt show much quality of peoples daily lives. An example of this was a complete lack of reference to Christmas and how people had enjoyed the day. Birthdays were mentioned but not in any meaningful way. The manager said that training on how to record would be taking place and that care staff rather than just nurses would be encouraged to write in them. This will help reduce the medical model currently being used. In contrast healthcare needs were well documented and lots of actions recorded about GP, district nurse, chiropody or other healthcare professional visits. Evidence of discussion with the GP about healthcare matters was seen and where appropriate the GP had written in care records. From records seen, discussion with the manager and relatives it was clear that peoples health and behaviours had improved since coming to the home. One relative was able to tell us about this as her family member had shown signs of ill-being at the last home s/he had stayed in. Since coming to Avon Lodge however the relative had seen a marked improvement in the persons mood, behaviour and communication. We saw this person and observed contact with others and found that s/he showed sign of well-being all the while we were at the home. We did a check of medication on one floor of the home. We saw from minutes of a staff meeting held in December 08 that an internal medication check had been done that was disappointing. The findings were discussed with staff. We found that medication is kept securely in a locked room with locked cupboards that meet regulations about medicines safety. Photographs of each person are at the front of their medication record sheets and each sheet was properly filled in with no gaps. As the home has not been open long, a programme of regular medication review hasnt yet started although the manager said they would aim for three monthly reviews. The medicines fridge was seen with a minimum/maximum thermometer in place. This showed the temperature to be slightly high. Records of daily checking of the temperature were seen. No medicines subject to legal controls were being given to anyone at this visit. However a controlled drugs book was seen that had been properly filled in when a person had had this type of medication. From the check we concluded that medication was being given safely, properly recorded and kept securely. From the structured way we watched people in the home we were able to see that they were treated with dignity and respect. Overall from the observation, staff good Care Homes for Older People Page 16 of 36 Evidence: contact with people with no signs of negative or neutral contact. Staff spent time with people and treated them as valuable human beings in their own right. People werent patronised and wherever possible were given information and choice about how to spend their time. (See standards 12 -15 below for more about this). People were discreetly assisted e.g. with being taken to the toilet and it was evident that staff have built good relationships with them and their relatives. We discussed with the manager the use of language that could be patronising or demeaning e.g. over-familiar use of terms of endearment and gave information about how this can negatively affect older people. The manager said she would discuss the matter with staff. The advanced care plans are being used to help prepare for the eventual end of peoples lives and have been developed from a national drive to improve end of life care (called the Gold Standard Framework). As recorded above not everyone had the plan filled in. The plan includes how the person is to be cared for, meeting of specialist needs and who is to be present or contacted. We recommend that all the plans are filled in as soon as possible with as much information gained about peoples wishes around dying and death as far as possible. We saw that a complaint had been made about the end of a persons life where lack of proper communication had meant relatives werent able to be present when they wanted to. The manager said staff had learned from this and she would make sure it would never happen again. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a range of social and leisure activities that meet their needs. Encouragement of contact with the community would help people stay in touch with what is happening outside the home. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Satisfactory management of meals gives people daily variation, a balanced diet and social contact. Evidence: Daily activities take place on all floors but more particularly on the floors where people with dementia live. The activity co-ordinator had drawn up a weekly programme of activities that she does herself. We looked at the December programme.This included lots of Christmas preparation activities such as decorating, Christmas entertainment, a visit from a choir to sing carols, a local band also visited, a church service was held in the home, outings, outside entertainers and a Christmas reminiscence, among other events. A Christmas party had been held and relatives had joined people living at the Care Homes for Older People Page 18 of 36 Evidence: home for Christmas dinner. The packed calendar of events showed that Christmas had been well celebrated at the home. The manager and activity co-ordinator confirmed this. However, from reading peoples records no-one would have been aware that Christmas had actually happened! No references were seen about individual enjoyment of either the activity or the day in peoples care records. The manager said this was disappointing as staff had worked hard to make sure people enjoyed their first Christmas at the home. Activities records are kept by the co-ordinator although when the second floor opens she will be under more pressure to both do activities and record them in group and individual records. We looked at the records for each floor. People have leisure and social activities in their care plans. A group record of them is also kept. All records could have been more detailed about how people enjoyed the particular activity. We found the ground floor records less person-centred than the first floor. Some good records were seen that gave a clear picture of the particular activity e.g. one person went outside with the activity co-ordinator, collecting leaves and enjoying fresh air. It was recorded that she likes watching entertainment and dancing. However another persons records were brief about having a manicure and lacked detail about the persons enjoyment of it. We recommend that care staff write more in records about peoples taking part in any activity. This is an important part of their lives at the home and opportunities have been missed to record all the work that is being done to give people a good quality of life. We also found that information about peoples histories, likes and dislikes wasnt being fully used to plan activity and entertainment. In one persons records we found that s/he had a love of horses and tennis. We looked in the persons room but there was little evidence of this. We also found that some peoples social history/social profile forms hadnt been filled in as part of their care records. We did a structured observation of life in the lounge on the first floor of the home. The activity co-ordinator was off duty (but came in to meet us) so no structured activity had been planned. However staff put on age-appropriate music for people to sing along to. At first it looked like people were being left to themselves, but we noticed that staff came in and out of the lounge very often, spending several minutes at a time chatting to people or encouraging them to sing. This is called a butterfly technique i.e. spending short bursts of time with people so that they dont get overwhelmed and can enjoy the activity better, which is good practice. We did notice however that when staff left the lounge people quickly became more passive or fell asleep. Overall our findings were that people showed good levels of well-being. Staff contact with them was good and frequent. People that were more passive or withdrawn were Care Homes for Older People Page 19 of 36 Evidence: given more one to one attention. One person who was more withdrawn than others was offered frequent drinks. Staff sat with her/him so that s/he wasnt left out of the activity going on. People are taken out on short trips around the local area or further afield to places such as garden centres. Staff said they love going out. The activity co-ordinator showed she has lots of ideas for activities to keep people happy and stimulated. Crafts, gardening, cooking and exercise are just a few on offer. The co-ordinator had done training in what activities to provide for people. There is an activities room that had been decorated with a large card game mural painted on two walls that was bright and easy to see. We asked the manager about contact with the local community. She told us that she was hoping to arrange for young people locally to come and do work experience at the home. A local Church of England minister visits to take services. However, it wasnt clear how other peoples religious needs would be met if they werent protestant. The whole ethos and principle of the home is about respecting choice and dignity. The Statement of Purpose makes clear the individual nature of person-centred care being offered at the home. This is based around choice and how people want to live their lives. People are able to choose when to get up or go to bed, when to eat,(meals are prepared in the middle of the night if they want them), what to wear and what activity they wish to join in with. Records confirmed this. The emphasis is on the person not the institution, which is good practice. We were given copies of four weekly menus. From these we saw that a traditional English, meat-based diet is offered.Two choices of main meal are offered at lunchtime and also a cooked evening meal, again with two choices. We met the chef and asked about meals offered to people and which they prefer. The chef told us that relatives tell staff about individual likes and dislikes or allergies etc. Menus are made up of what people like to eat. All food is freshly prepared by the chef and home made. The only food bought in is cheesecake. We did part of our structured observation in the first floor dining room at lunchtime. The choice of meals for the day were sausage casserole or steak and kidney pie. People were shown plates of both meals and if able were given the meal they chose. For people with communication difficulties, unable to show a clear preference, they were given both on one plate and could either eat both or whichever they preferred. Staff wear flimsy blue plastic aprons while serving or helping with meals. We saw that one person was given a similar apron to wear to have her/his meal. This looked institutional and not in keeping with the person-centred way people were being helped. The manager said the person wearing the apron had asked to have an apron at Care Homes for Older People Page 20 of 36 Evidence: mealtimes. However, we suggest that getting different garments such as cotton tabards for people to wear would be more discreet and less institutional. Some people need help to eat their meals. This was done discreetly and in a kindly, patient manner. One person we observed was helped by a new member of staff. The person was unable to communicate with words and the staff member worked well to make sure s/he knew what was happening, was able to take time and was treated with respect. Halfway through the meal the person started to feed her/himself independently. Again s/he was praised and assisted discreetly and positively, all the while being spoken with and involved in the process. On other tables staff were also helping people to eat. Where several staff were at one table helping people we noticed that they spoke more to each other or others and less to the people they were helping. We discussed this with the manager as the mealtime experience for people being helped should be one to one and exclusive. We sampled the meal and found it to be well-cooked, tasty and nutritious. People showed clear enjoyment and engagement with their meals and again showed signs of positive well being. Staff were also able to sit and have a meal with them that added to the general positive atmosphere. People clearly showed that they liked staff joining them to eat. Care Homes for Older People Page 21 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory complaints management and recording makes sure that relatives of people living at the home can be confident in raising concerns about any aspect of their care. However people living at the home dont get information about complaints in ways they can understand. Proper management of abuse issues keeps people protected from risk of harm or abuse happening to them. Evidence: We saw information about complaints displayed in the entrance hall of the home. Complaints information was seen in both the Statement of Purpose and the service users guide. Relatives spoken with were clear about how to make a complaint if they needed to. However it wasnt clear how people with dementia are supported to be able to make complaints as information about this isnt in an accessible format (see standards 1-6 above). Thought should be given to making information about the complaints process easy for people with dementia to understand. Eight complaints had been made since the home opened. We looked at the records. These showed complaints about laundry, meals, responses to call bells, miscommunication from agency staff to relatives, a complaint from a person living locally about external lighting and an allegation of abuse by staff towards another staff Care Homes for Older People Page 22 of 36 Evidence: member. Complaints were properly recorded with clear information about investigations and results. The manager discussed issues raised with us and showed a strong response to poor staff practice. Staff are left in no doubt about what is acceptable. All complaints were dealt with within 28 days. The allegation of abuse had been investigated and the result was that it was unfounded. The manager had taken swift action when the allegation was made and informed all the relevant agencies quickly. We were told about it as soon as it happened and also received a written notice of the allegation and the action taken. Staff we spoke with were clear about what can be regarded as abuse and said they would feel confident in reporting it if necessary. Training has been done by a number of staff and a programme of safeguarding adults from abuse training continues. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well appointed and decorated, physically accessible and meets their needs. Evidence: The home was registered by Commissions registration team in July 2008. Its purpose built and follows guidance given under the National Minimum Standards for new build homes. The interior has been designed with guidance about safe environments for people with dementia. Its built over three floors, with a ground floor (Orchard Gardens) for nursing care, Meadow Rise on the first floor for people with dementia and Treetops View on the second floor, also for people with dementia. At the time of our visit only Orchard Gardens and Meadow Rise were open and inhabited. Treetops was due to open the following week. Each bedroom is of a size accessible for wheelchair users. On each floor bedroom sizes vary between 12 and 14 square metres of usable space. Each bedroom has its own ensuite bathroom that has a toilet and washbasin. Three double rooms also have an ensuite shower. There are also large, assisted bathrooms on each floor. Communal rooms include lounges and dining rooms with serveries attached. All communal rooms are well lit e.g. the dining rooms have a total of nine ceiling lights and four wall lights. In the lounges there were similar numbers of lights that made the rooms look bright. Care Homes for Older People Page 24 of 36 Evidence: All rooms and communal areas are painted in pastel or neutral colours with no heavy patterns that could confuse people more. Toilet doors are painted in bright primary colours to make them easy to find. All doors have signs on them indicating their use. Beside each bedroom door a small box is attached to the wall. These are used as memory boxes. People can put in them photos or objects that have special significance for them. In this way they will be able to recognise their own rooms. This is good practice. On each bedroom door paper name plates had been put up with black letters on yellow paper. (This is recognised by the Royal National Institute for the Blind as the most accessible colour scheme for people with sight difficulties). Whilst this is good practice, some of the signs were looking torn and tatty. Also because they were all the same they gave a somewhat institutional feel to corridors. The home has a room known as a snoezlen. This is a room used for relaxation purposes if people become agitated. The equipment in the room is designed to give a feeling of relaxation. Some of the equipment is tactile and includes fibre optic lighting that changes colour and a glitter ball that throws coloured light patterns on to the wall, among others. Bathrooms were large and had bathing equipment to assist people in and out of the bath. It was disappointing to note in one bathroom that the area was full of boxes of continence supplies that reduced the space available and made the room look institutional. Some of the boxes were empty but were left stacked in the room. We discussed this with the manager who said that the boxes would be removed. Throughout the home we saw objects from times gone by that would help people recognise their surroundings. These included a 50s-style radio, with age-appropriate music being played on it and an old-style telephone. There were also cushions that had been made that people could play with. These had pockets and different textures for people to feel and different things hanging from them. Some people had soft toys. We saw lots of picture books in lounges on subjects including the war, the military and childrens picture books from the forties and fifties. We didnt see rummage boxes but the manager said although these had been put in place they had been almost too successful as people had taken things from them and squirrelled them away in their rooms! We saw people at home in the environment and enjoying all the space. Most people stayed either in the lounge or in their rooms. If they were walking about it was purposeful and not aimless. The home was clean and hygienic at this visit and smelled fresh. Staff were seen cleaning areas and making beds. We did notice crumbs under some chair cushions and the manager said that all sofas and chairs are regularly checked to make sure they are Care Homes for Older People Page 25 of 36 Evidence: clean. There were no hazardous substances left around the home although we did see a bottle of shampoo left in one of the bathrooms. The manager made sure this was quickly removed. Care Homes for Older People Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from sufficient numbers of care staff to meet their needs. Satisfactory progress with National Vocational Qualification in Care training makes sure people are looked after well. Proper checks on staff before they come into the job keeps people living at the home safe and protected. People living at the home benefit from having a well trained and qualified staff group that are able to meet their needs. Evidence: From the Annual Quality Assurance Assessment (AQAA) that we require home managers to fill in once a year, the manager had written: Our staffing levels and skill mix meets the needs of residents. The numbers of staff on duty considers the dependency of residents so it is at a higher level to provide the specialist care necessary. Further, the AQAA went on to describe the recruitment process i.e. only staff with experience in care work or able to show a clear understanding of dementia, are taken on. Care Homes for Older People Page 27 of 36 Evidence: We looked at rotas and saw that numbers of staff are adequate to meet peoples needs. Some agency staff had been used on occasion but the manager said this had been whilst permanent staff were being recruited. Therefore use of agency staff had lessened as new staff started. Staff commented about staffing in surveys we received: There have been occasions where staffing has been difficult when we first opened. Hopefully as staff increase this will not be such a problem. Another said: As we are a new home we are still recruiting staff but do our very best to carry out a high standard regarding care and needs of residents. We spoke to staff who said they were happy working at the home and felt appreciated. Staff are now being assigned to work regularly on each floor that helps with giving regular care to people. From the AQAA we saw that five care staff already have a National Vocational Qualification in Care and twelve staff have been enrolled on NVQ courses locally. At the visit the manager gave us more updated information about this: of a total of thirty staff nine have NVQ at level 2 and one has it at level 3. Seven more have been enrolled to do it and three have almost finished it. The National Minimum Standards recommendation is that at least 50 of staff have level 2, so currently the home doesnt meet the minimum level. However, good progress with fast-tracking staff will help this target to be reached. The target will be followed up at future inspections and Annual Service Reviews that we do. We checked a sample of staff records. These all showed that documents required under regulation had been seen and copies were kept in their files. These included Criminal Record Bureau disclosures, two references, full job applications with employment histories filled in, interview notes, qualifications and training and a statement of health and fitness to work. The manager said that waiting for CRB checks had put pressure on staff numbers but these were all now received. The manager was able to tell us about judgements she had made about taking on certain staff e.g following up references, speaking with former employers etc. Full records were seen in each persons file. Staff told us that they had had a two week induction period when they started work. This included basic essential training in moving and handling, safeguarding adults from abuse, food hygiene and dementia awareness. The manager said that twenty-one staff had done a two day course on dementia care in October and further dates were planned. Two staff were doing safeguarding adults from abuse training on one of the days of our visit and others had done it or were booked to do so. All staff would be doing training in the Mental Capacity Act and Deprivation of Liberties (new legislation). The manager had stated in the AQAA that plans for improvement include a training matrix that will show what training each staff member has done and what they need Care Homes for Older People Page 28 of 36 Evidence: to do so that the manager can make sure all training is up to date. We saw an email from a dementia care trainer who had offered free training sessions that the deputy manager would be booking for staff. Regular staff meetings were being held that showed both a training and supervisory element. Staff are able to discuss training they would like to do and this is discussed at staff meetings. Care Homes for Older People Page 29 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home thats run by a trained and experienced manager who is registered with the Commission for Social Care Inspection. Proper mechanisms for checking quality of care for people keep them safe and protected. Satisfactory management of peoples money makes sure they are protected from financial risk. Lack of regular opportunities for supervision could fail to help staff to reflect on their working practices and keep people safe. Satisfactory management of health and safety in the home makes sure people are kept safe. Care Homes for Older People Page 30 of 36 Evidence: The manager Kathy Marshalsea, a trained nurse, has experience of running homes and the inspection process. She was welcoming and open to our visit and gave us as much information as we needed. Ms Marshalsea was able to show that she is committed to working in a person-centred way and was seen to have positive, loving relationships with people living at the home. Staff told us that she has an open door policy for them, they know that she is all for the residents and we saw her helping them with the meal at lunchtime. From comments received in surveys staff stated that the manager always visits the residents and staff regularly throughout the day and all information is passed on to the staff. The staff member added the manager comments how well staff work and also gives a lot of praise to staff. Another commented: the manager is very supportive. We have regular meetings to discuss my job role and ways to better my service to residents. Whilst Ms Marshalsea has much experience of training in working with people with dementia and has kept up her nursing qualification, she said she plans to do the registered managers award so that she is fully up to date with her role as care home manager. Although the home has only been open for six months, lots of internal checking of quality has already been done. A monthly audit of quality is done by people that are independent from the home itself. The operations manager also does her own bimonthly audit. A survey had been done that showed an overall score of 88 satisfaction with the home since its opening. Comments received were all very good and one person said s/he had already recommended the home to others. Stakeholders such as relatives, social workers and healthcare professionals were asked to fill in the surveys. One stakeholder commented: New home, very nice manager and staff. Professionally meets the high needs of current residents. Will continue to place people at Avon Lodge. The internal audit is very detailed and follows the National Minimum Standards that we inspect against. Again the overall scores were high and recommendations had been made to address any issues picked up. We did a check of money kept for each person living at the home. Cash records are kept on computer and we checked the records against the balance of money held. All were correct. Receipts were seen and records showed reasons for money spent. We discussed supervision with the manager and looked at staff records. Until recently the home had been without a deputy manager. This had meant the manager was trying to do each staff members regular supervision. Because this wasnt possible staff supervision sessions had fallen behind. We looked at minutes of a number of regular staff meetings held that also had a supervisory element to them. Staff are encouraged to put items on the agenda which are then discussed. Issues such as medication, daily records, nursing and care duties were discussed. The manager gave us a plan of supervisions to be done on the second day of our visit. This showed how many people Care Homes for Older People Page 31 of 36 Evidence: had had supervision, how many needed it and who would be responsible for making sure it happened. However some staff told us they had only had one supervision session since starting work (and following their successful induction period). Whilst its clear attempts are being made to address the issue, it may be difficult to reach the recommended number of sessions to be held in the first year (six sessions). Peoples records are kept securely in nurses offices on each floor. These are locked when not in use. Records are kept confidential and no judgemental or inappropriate comments were seen. From the kitchen inspection we checked storage areas and cleanliness of the kitchen and store rooms. South Gloucestershire Council recently gave the home a 5 star food hygiene rating. In the store rooms we saw opened packets of foodstuffs that werent properly sealed and should be in airtight containers. We advised the chef to make sure this happened. We saw lots of fresh vegetables. The fridges and freezers were looked at. Records of fridge and freezer temperatures were regularly recorded with no gaps. The kitchen is deep-cleaned done once a month and was very clean at this visit. The Fire Safety log book is kept in the entrance hall. This means that if theres an evacuation the log book is easily available and includes all the information the emergency services might need. Weekly checks of the fire alarm are done and we observed this while we were visiting. Regular fire drills are held and outcomes written up. An issue had been picked up whilst doing an unannounced drill when staff failed to take notice of it. This had been swiftly dealt with by the manager. Records of staff fire safety training were also seen. Weekly checks of fire safety equipment and water temperatures were seen as well as records of contractor visits. Care Homes for Older People Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service user guide should be put into a format that people with sight difficulties or dementia are able to see clearly. Clear information about equalitities and diversity should be included in the Statement of Purpose. This will make sure people get the information they need about living at the home and how specialist needs can be met. The amount of fee payable should be recorded in the service user guide so that people are aware of the cost of living at the home. Care plans should be written in person-centred ways that puts people at the centre of them and shows they are consulted wherever possible about their care. This will make sure peoples views and preferences are taken into account as well as their health and physical care needs. Ways should be found to make sure people with dementia know how to complain if they need to and how any complaints will be dealt with. This will make sure people are given information they need in ways they can understand. Every attempt should be made to make sure each staff Page 34 of 36 2 2 3 7 4 16 5 36 Care Homes for Older People member has the recommended amount of one to one supervision sessions. This will make sure people are cared for by staff that have regular opportunities to reflect on their work. 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