Inspection on 06/03/09 for Avon Park

This inspection was carried out on 6th March 2009.

CSCI found this care home to be providing an Adequate 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.

Other inspections for this house

Avon Park 15/06/09

Avon Park 22/03/07

Avon Park 11/10/05

Avon Park 12/05/05

Avon Park 19/10/04

Avon Park 27/04/04

Avon Park 15/04/03

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avon Park 66 Southampton Road Park Gate Hampshire SO31 6AF     The quality rating for this care home is:   one star adequate 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: Michelle Presdee     Date: 0 6 0 3 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 26 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Avon Park 66 Southampton Road Park Gate Hampshire SO31 6AF 01489574616 Telephone number: Fax number: Email address: Provider web address: alexandernethersole@btinternet.com Name of registered provider(s): Type of registration: Number of places registered: Mr A Nethersole,Mrs Nethersole care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 30 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category ; Old age, not falling within any other category (OP) Physical disability (PD) Date of last inspection Brief description of the care home Avon Park is situated in a quiet residential area of Park Gate and is a short distance from the local shops and amenities. The home is set within its own grounds and has a large car parking area at the front of the home with attractive flowered borders. Accommodation is arranged over 2 floors with stair lifts between floors. The rear garden is wheelchair accessible and has a walkway with grab rails for service users, Care Homes for Older People Page 4 of 26 Over 65 30 0 0 30 Brief description of the care home the garden is well maintained and mainly laid to lawn with trees shrubs and flowers. The home is registered with the Commission for Social Care Inspection for a maximum of 30 older people and older service users who have a physical disability. Fees range from £475 - £580 per week. Care Homes for Older People Page 5 of 26 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: one star adequate 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: During this inspection (we) The Commission were assisted by Mr Nethersole the proprietor of the home and senior staff on duty. The manager and deputy manager were both unavailable on the day of the inspection. An Expert by Experience also visited the home during the inspection. An Expert by Experience is used to describe anyone who use services, who have chosen to become more closely involved with the organisation developing their skills, knowledge and expertise. Their findings have been incorporated into the report. We were able to speak to the majority of people in the home, some in more depth than others. Staff on duty were spoken with as were visitors to the home. Feedback was of a positive nature. The home sent us their Annual Quality Assurance Assessment (AQAA) back on time, which detailed information on the home. A tour of the home including all communal areas, the kitchen, the laundry and some bedrooms chosen at random was taken on the day. Paperwork including assessments, care plans, menus, staffing records and Care Homes for Older People Page 6 of 26 safety checks were seen. All this information has helped form judgements in this report. What the care home does well: What has improved since the last inspection? What they could do better: 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 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 9 of 26 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. Assessments are undertaken before people move into the home to ensure their needs can be met when they come to the home. Evidence: The pre admissions assessments of four people were viewed; one of these people was on a two-week stay to see how they liked the home. It was clear evidence is gained from a range of sources, which gives carers a picture of the person and what their needs are likely to be. Care staff explained sometimes when the person comes into the home they do not present as the pre admission assessment suggests. Evidence was seen when this had happened a range of health professionals had been contacted to re-assess the person. The home does not provide intermediate care. Care Homes for Older People Page 10 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not detailed enough for all people living in the home to ensure staff are aware of their current needs. Peoples health needs are met and they have access to a range of services. Medication procedures are not followed and could pose a risk to people. Evidence: Care plans for three people were viewed. These were discussed with a senior member of staff. It was noted all care plans follow the same format. Each has written information on various areas of the persons care. These are reviewed on a monthly basis in the format of a tick box, where there is space to add notes, although it was noted no notes had been added. A risk assessment on each persons mobility had been undertaken but risk assessments in other areas had not been completed. For one person it was clear the care plan was relevant and up to date and gave an accurate picture of the persons needs and abilities and how carers should assist this person. For the other two people it was clear the care plans were a little out of date and did not reflect the changing picture of these two people. Daily notes went some way to explain the current situation but relevant risk assessments had not been completed Care Homes for Older People Page 11 of 26 Evidence: and it was time consuming to read all the relevant daily notes. Care staff explained they were not allowed to write on care plans, but had a system where they stared where changes are needed and the manager then makes the necessary changes. People living in the home are able to choose their own GP surgery in the area. Records demonstrated a range of health professionals visit the service on a regular basis. All this information was recorded in each persons file. A health professional visiting on the day confirmed people were always seen in their own room or in the medical room to maintain their privacy. They stated they had a good working relationship with the home and were contacted appropriately. The home uses a nomad system, which is delivered into the home on a monthly basis. On the day of the inspection it was clear the medication procedure was not being followed. One member of staff was signing the medical administration records for that morning and for the two previous evenings despite not administering the evening medication. The member of staff stated she was aware she was not following procedure and should not have been completing the records. It was also clear when looking at medical administration records there were gaps where it was not possible to establish if the person had received the medication or not. The storage of medication was checked and it was noted this and controlled medication was being stored appropriately. No one in the home was currently on medication but records were seen and it was clear controlled medication had been returned to the pharmacist. When checking medication against the medication administration records it was found most were correct. For one person the details involving the administration times and dosage were different to what the staff were administering. No records could be found to support why the staff had changed the time and dosage. Staff explained and certificates were seen that staff had received training in Boots care of medicines foundation module. Staff explained this had taken place one afternoon. Given the shortfalls in medication it appears this has not equipped staff fully on the medication procedures in the home. Evidence was seen that peoples privacy and dignity was respected. Care plans gave details of a persons preferred name of address. Some residents have their own phonelines or mobile phones. A resident said the Manager would take her to the doctor or to an appointment in her own car. Staff were observed knocking on residents doors and helping residents in a caring friendly way. One resident said, They (staff) are very discreet, everyone is so kind. Care Homes for Older People Page 12 of 26 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 can choose how they spend their time and have a range of social activities to join in if they wish. People enjoy their meal times and have a choice of different home cooked meals. Evidence: The Home has various activities, which residents can get involved in. During the visit one of the residents was laying up for a bingo session at which residents give 50p each and surprise prizes are wrapped up. Over 10 residents were seen enjoying themselves. We were advised there are regular church services involving various denominations, quizzes, art classes, and movement sessions. Golden Oldies sing-alongs are organized several times a year by one of the visitors. Music for health workshops, special themed parties like a recent St Valentines Dinner, beetle drives, scrabble and pub lunches. One of the lounges had a jigsaw laid out for a resident and a keyboard was in view. Papers are delivered daily and there is a shop once a week for toiletries and sweets. One resident stated, You enjoy a bit of life here; you could be a bit lonely in your own home. Its nice here, easy going and nothing to worry about...you couldnt find a better Home than this. People confirmed their visitors could call at any time. A notice is displayed in the home Care Homes for Older People Page 13 of 26 Evidence: to this effect asking people to respect meal times in the home. In the AQAA we were told residents families and friends are always welcome to join us for meals and snacks. This is a regular occurrence even on Christmas day and other holidays, at no extra charge. In the AQAA we were advised Residents are consulted on every aspect of their life within the home (e.g. menu choices and location for meals; suggestions for activities\outings; choice of dentist, chiropodist, hairdresser; their day to day routines). People on the day reflected they had choices. Some people were pleased they could have meals in their rooms. Others were pleased they did not have to join in the activities and were able to stay in their rooms. The home has created a wet room, which now gives people a choice of a shower or a bath. People stated they liked the food at the home and had missed the chef when she had been on holiday recently. Residents enjoyed their lunch and tables were laid up nicely (two residents have their own cutlery) with a choice of drinks on the table. Roasts were served three times a week, but at a recent residents meeting it was asked if this could go down to twice a week, which has happened. There is always a salad on offer and a choice given at lunch and tea, although on the day of the inspection the choice was either ham and/or fried egg and peas with chips or mashed potato. Pudding was either treacle sponge and banana custard. The chef was making 3 different cakes for the weekend. Care Homes for Older People Page 14 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident if they complain their complaint will be acted upon. People are not protected regarding adult protection, as staff are not aware of the adult protection procedure. Evidence: In the AQAA we were advised residents are actively encouraged and feel comfortable making their comments and concerns known to us and we attempt to deal with them quickly and to find a suitable solution/remedy. Details of the complaint procedure were displayed in the home. We were advised the home has received no complaints and the Commission has received no complaints. People stated they would have no concern raising any issue with the manager or the owner and felt their concern would be dealt with. The residents meeting identified areas where people felt things could be improved and these had been actioned. In the AQAA we were advised abuse and protection are key aspects of staff members annual supervision programme. No staff spoken to on the day could recall undertaking any specific training regarding adult protection. No records could be found to state when the last training had taken place in this area. When staff were asked what they would do if they needed to follow Hampshire adult protection procedure no staff were aware of the correct agency to be contacted. Care Homes for Older People Page 15 of 26 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 live in a clean, homely and well maintained environment. Evidence: In the AQAA we were advised the home is well decorated and maintained and residents are consulted on choices of furnishings. It is well lit and every attempt is made to keep it at an optimum temperature with individual rooms all having their own thermostats on the radiators. All residents rooms have en-suite facilities, some with additional showers and all vary in layout, decor and so on, thus making them individual. Residents are encouraged to make their rooms their own with pictures, knick-knacks and some items of furniture. They can come and go to their rooms as they wish. On the day of the visit all areas of the home were clean and no unpleasant odors were detected. Some bedrooms were chosen at random and viewed and some people were spoken to in their rooms. All were clean and had been personalised. People stated the laundry worked well and their clothes and bedding was always clean. One person stated, who had been there for ten years, Its very comfortable here and Im quite content. Everything is spotless. Im well cared for and looked after. Several residents who use wheel chairs and frames reported they had no trouble getting around. One resident who has to use a wheel chair said, Its all flat around the garden and one of the staff push me. The laundry room was seen and was well organised. The home has a new wet room Care Homes for Older People Page 16 of 26 Evidence: giving people a choice of a shower or a bath. The home has a large garden with suitable furniture for people to sit out. Care Homes for Older People Page 17 of 26 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 are supported by a static group of staff that have had the necessary checks to ensure peoples safety. Training in the home does not ensure staff are up to date on all the necessary key areas to meet peoples needs. Evidence: On the morning of the inspection five members of care staff were on duty alongside the housekeeper, cook, laundress and the proprietor. We were advised this is the usual staff pattern, with three members of staff working an afternoon session and two members of staff work a waking night. All comments from people supported there was always adequate staff on duty to meet peoples needs. Comments included, They look after you quite well, theyre a great friendly lot. Another resident said, Everyone is so kind. It was clear staff and residents had a good relationship. There was a happy banter between staff and residents. As one carer left a residents room, the resident said, Shes a lovely person. A carer who was running the Surprise Bingo was joking with the ten or so residents around the table. Another who was helping a resident with her lunch was chatty and cheery. In the AQAA we were advised staff retention remains very good. We adhere to the policies and procedures relating to staff recruitment and attempt to select staff carefully so that they will complement our staff group and support and care for our residents at the standard we expect. The staffing records of two members of staff Care Homes for Older People Page 18 of 26 Evidence: were viewed. It was clear all the necessary checks and references had been obtained. In the AQAA we were advised well over 50 percent of staff have achieved a National Vocational Qualification Level 2. On the day of the visit it was not possible to establish what training each staff member had undertaken and if they had undertaken an induction period. Staff advised they had shadowed people when they first started. People advised they had recently undertaken moving and handling training, care of medicines training and fire training. It was not possible to establish if staff had in date training in infection control, basic food hygiene, and first aid and adult protection. Care Homes for Older People Page 19 of 26 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. The home is well managed and run in the best interest of the people who live there. Evidence: Both the registered proprietor and the registered manager have worked together as a team, on a daily basis, for the past eighteen years. Both have achieved NVQ Level 4 and the Registered Managers Award. People spoken to stated they were always available and were very approachable. One person stated, I didnt even know she (the manager) was away. I cant praise her enough. Another person said, (The owner) knows us all personally. The home carries out effective assurance and monitoring. Some people explained they had been given questionnaires on arrival and every so often. People attend residents meetings; minutes of the meetings are distributed to residents. We were advised residents meetings are going to be opened up to relatives to give them the opportunity to express any ideas. A range of things are brought up including food suggestions, news about latest improvements to the home like the new handrails in Care Homes for Older People Page 20 of 26 Evidence: the garden. The registered manager and proprietor are not the appointee for any persons finances. They manage the personal allowance for a few people in the home. Staff reported they received support from the manager and had an annual appraisal, which was recorded. Staff were not aware of receiving formal supervision sessions and no records could be found of formal supervisions taking place. In the AQAA we were advised the home has a range of policies and procedures relating to health and safety, which are reviewed on a regular basis. The homes laundry was well organised and took into account relevant health and safety legislation. It was not possible to establish staff have received relevant and in date training in first aid food hygiene, infection control and an induction in line with Skills for Care foundation stage. It was clear from service records seen all equipment in the home is routinely serviced. The fire logbook was seen, which indicated the necessary test had been done weekly but the monthly tests were two months out of date, but prior to this had been routinely checked. Care Homes for Older People Page 21 of 26 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 22 of 26 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 1 7 15 Care plans must be kept up to date to reflect the changing needs of the person. Care plans must include relevant risk assessments. If care plans are not kept up to date it is difficult for staff to know the changing needs of each person. Risk assessments need to reflect the risk for that person and these will not be the same for each person. 22/05/2009 2 9 13 The medication procedure must be followed, ensuring medication is signed when administered. The dosage of medication must never be changed without there being clear evidence from the doctor. It is very dangerous if medication is not signed for when administered. It is possible for staff to forget if 22/05/2009 Care Homes for Older People Page 23 of 26 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 they administered medication and for someone to be given extra medication if the records are not clear. The dosage or time a medication is administered must never be changed without evidence from the doctor as this could seriously effect the person taking the medication. 3 29 18 Staff must receive training in the areas of infection control, basic food hygiene, first aid and adult protection. Staff must receive regular training to ensure they are competent in all areas and are able to keep people living at the home safe. 4 36 18 All staff must receive a minimum of six formal supervision sessions in a twelve month period. Staff must be given supervision to ensure they are aware they are following relevant procedures and give them an oppourtunity to discuss any areas of learning they may have. 03/07/2009 12/06/2009 Care Homes for Older People Page 24 of 26 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!