CARE HOMES FOR OLDER PEOPLE
Avon View Residential & Nursing Home Loring Road Christchurch Dorset BH23 2GZ Lead Inspector
Trevor Julian Key Unannounced Inspection 15th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Avon View Residential & Nursing Home Address Loring Road Christchurch Dorset BH23 2GZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 485170 01202 482280 www.dorsetforyou.com Dorset County Council Amanda Mary Elliott Care Home 80 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (50), of places Physical disability (10) Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home may accommodate a maximum of 25 service users who require nursing care. The home may from time to time, admit persons between the ages of 60 and 65. Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. 31st January 2007 Date of last inspection Brief Description of the Service: The home is located in Christchurch and there are public transport links to the town centres of Bournemouth and Christchurch. The home was opened in October 2006 having transferred residents and staff from the old premises. The building offers accommodation to a maximum of 80 people, in the main building there are three floors; the ground floor offers a service to people needing specialist dementia care, the first floor is for older people and the second floor is a 25 bedded nursing unit. To the side of the building is another unit specialising in intermediate care helping people to return to independent living. The accommodation includes single rooms only and each has en-suite facilities including walk-in shower. There is a communal bath on each of the floors. To the rear of the premises there is a secure garden. Limited on site parking is available. All residents are referred through the local authority care management process. In November 2007, the weekly fees were between £443 – £685 for nursing places. Additional charges were made for hairdressing, chiropody, etc. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was started on Thursday 15th November 2007, continued on 16th November and concluded on Thursday 29th November 2007. On the first two days the lead inspector was accompanied by a second inspector Mandy Porter. Prior to the visit the manager had returned an Annual Quality Assurance Assessment (AQAA) giving details of management systems and basic needs of the residents. Residents, visitors and staff were invited to give their views through survey forms. There had been two adult protection conferences, there were no requirements made following the investigations. Eight files were case tracked during the visit and further evidence was gained fro discussion with residents, visitors and staff and a tour of the premises. Since the last inspection, some improvements have been put in place but by the time of the visit the benefits had not been fully realised. What the service does well:
One comment card read. “I haven’t much to tell, I rather like it here!” Many of the comment cards were very clear in their appreciation of the services offered by the home and the dedication of the staff. The home’s thorough admission process helped to ensure that people were offered a placement only if their needs were able to be met. All pre admission assessments reviewed were of a high standard. People in the home felt they were well cared for and the staff treated them with respect this was observed during the observation carried out in the specialist Dementia unit. Comment cards showed that community healthcare professionals had seen improvements in the home but felt that there was room for outstanding issues to be addressed. The scope of activities offered to residents had continued to improve and many people reported enjoying the regularly organised excursions from the home. The programme seen was offered to all but tailored to particular groups. The activities took place around the home to improve accessibility. People said they were able to exercise choice in their daily lives. At mealtimes they had a choice of three main dishes or a cold alternative. Some commented that they would appreciate more choice although the standard of food was described as very good. The home routinely monitored the nutritional intake of the residents. There was a clear and accessible complaints procedure and the residents said they felt able to discuss any concerns with staff. All staff have training and updates on responding to allegations or signs of abuse. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 6 The premises offer very high levels of accommodation and the room sizes allow for any hoisting equipment needed to aid the resident. The rooms in the main home had been personalised by the occupants. A call alarm system was available throughout the home and provided reports to ensure the calls were answered in a reasonable time. It also provided information on trends which was beginning to be used in care planning and resource management. It was noted that soap dispensers and paper towels were not provided in the residents room this was needed to help with infection control. Mrs Elliott immediately addressed the issue and by the third visit half the rooms had been provided with the items and the contractor was returning to finish the installation in the remaining rooms. Staff had a good knowledge of infection control and had received training. The home had a good recruitment procedure to ensure that positions were offered to suitable applicants. The training programme generally ensured that staff had the required knowledge to meet the needs of the residents. Staff commented that the authority’s training was of good standard. What has improved since the last inspection? What they could do better:
Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 7 The standards of care plans seen were generally good. However, on the nursing unit, one file seen contained out of date information and the nutritional assessment had no evidence that the objective was reasonable or agreed with the individual. Medication practice was much improved but for some, as required, medication the audit trail was not clear. The home’s statement of purpose clearly describes the home as able to cater for palliative care. As found previously the home did not have a policy on provision of palliative care and also the staff had still not received training. The Commission has subsequently been advised that a policy has now been introduced and the staff are receiving training and support from the MacMillan Cancer Support Team. The home is also starting a training programme for all staff in the New Year. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s system for admission helps to ensure that the home has the facilities to meet the needs of the individuals. EVIDENCE: The files seen showed that pre admission assessments were completed for new residents on each unit. The assessments included all the recommended topics and were complete to a very good standard. The AQAA confirms that all prospective residents have a single assessment, care plan and medical summary. The manager and deputy complete all assessments. Initially, all placements are offered as a six week trial when a review is completed to ensure that the home is suitable. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 10 One person seen in the intermediate care unit said that her family had visited the home and told her the place was suitable to help her “get back on her feet”. Three residents seen on the intermediate unit said that they had clear goals to achieve before they were able to go home. They said that they received very good support from the teams working with them. The deputy manager responsible for the unit showed statistics, which showed good success with over 2/3 of people leaving the unit, returned to their own homes. The deputy manager had recently visited a nearby intermediate care service and was revising the statement of purpose for the unit. The existing documents seen referred to the National Care Standards Commission and this would be revised in the update. In the two files checked in the intermediate care unit, one included a copy of their contract the other the contract was missing. A senior carer assured the inspector that there was a contract and that it would be returned to the file. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning has generally improved and is overall good. However, issues noted on the nursing unit mean that the information contained in the plans do not always hold relevant information. Medication practice had improved across the home helping to ensure the items are correctly stored and administered. EVIDENCE: In each of the units there were individual care plans in place for each resident. In the intermediate care unit each file see had a list of individual goals and there were updates stating when the goal had been achieved. Each week there was a multi disciplinary meeting to discuss each persons’ progress and a review of the goals to check they remained appropriate. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 12 In the nursing unit one of the care plans seen related to a person admitted for palliative care. The preadmission assessment had been developed into the care plan and included assessments for falls, use of bed rails, mobility, pressure sore risk, nutrition, body mapping. Some of the assessments did not fully consider the issues surrounding palliative care. The care plan had no information around palliative care needs or the resident’s knowledge of the diagnosis. The plan did not include social needs this was the case in another file seen. There was no indication why some medication was prescribed. The nutritional care plan described a high calorie and high protein diet. There was no evidence that this was catered for. There was no evidence that the objective was reasonable or if the individual could tolerate such a diet. The care plan showed updated information however, previous information was also included which could lead to confusion. The home’s statement of purpose clearly states that the nursing unit is able to provide palliative care, at the time of the visit none of the staff had received recent training in Palliative care although training was planned for early in 2008. There was still no palliative care policy. Since the inspection, the Commission have been advised that palliative care training has begun with support from the MacMillan Cancer Support team and a policy and handbook provided and is accessible to all staff in the home. The resident’s family said they were aware of the care plan but had not been directly involved with its development. They felt the staff were approachable and well supported by the MacMillan service. The staff managed her relative’s food well and were aware of her likes and dislikes. The family were always made welcome when they visited. Another recently admitted resident said she was having problems attracting the attention of staff and the home was arranging for a new device to be added to the call alarm system. Since the last inspection, the staff had been closely monitoring accident reports for trends. There had been referrals for healthcare assessments and the home’s Occupational Therapist carried out analysis. Comment cards from healthcare professionals continue to voice concern about communication in the home. One comment was that it was often difficult to contact the person who had made the call for assistance. Another said that instructions left were not always followed a sentiment echoed by a comment card from a care manager. One person said that they had perceived an increase in referrals which weren’t always appropriate. One person did feel that communication had begun to improve over recent months. Another stated that the staff were hardworking and dedicated but it appears that there are too few to cope with the heavy workload. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 13 The home uses a monitored dosage system. The controlled medication was found to be correctly stored and correct and appropriately recorded. In one case, the audit trail was not clear, especially with meds that are as needed (prn) the number held did not match the recorded number. Another short term antibiotic was reviewed and the correct number were on the trolley. A medication fridge was in use for temperature sensitive items. A minimum and maximum thermometer was in use and the temperatures were recorded and reset. In the intermediate care unit, the residents brought much of the medication into the home. There were clear audit trails and there was evidence that handwritten entries were checked by a second person to reduce the risk of transcription errors. Throughout the visit, a very good rapport was observed between staff, residents and visitors. People said that the staff were considerate and approachable. We took time in the specialist care unit to monitor the interactions between residents, staff and visitors. It was during the planned activity time. Several people were sat around a table joining in with some songs. Other people sat in armchairs were observed joining in. Some people were dozing. Throughout the observation the staff were tuned into the needs of the individual, one new resident appeared very settled and was fully involved but part way through the observation she became unsettled and went off to seek a member of staff who clearly was able to address the concern allowing in the resident to rejoin the group activity. Residents were regularly checked to see if the were drinking. One resident helped the staff to lay the table and several people started to congregate in readiness for the meal. The staff seen were relaxed with the residents and there was clearly a good deal of mutual respect. A review of care plans in the unit showed they were comprehensive and of a high standard. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s staff work hard to ensure that all residents engage in social interaction and receive appropriate mental stimulation. Residents are encouraged to make choices about their daily lives to improve their sense of wellbeing. EVIDENCE: The home’s activity organiser had settled into the role and was developing a comprehensive programme providing good levels of stimulation. The programme ensured that activities took place around the home to improve accessibility to all wishing to participate. Several people commented that they enjoyed the variety of pastimes offered but that there was no compulsion to join in. During the afternoon one group of residents were listening to a tape of poems and anecdotes the tape was stopped at the end of each section and the residents then chatted about their own related experiences. The home arranges regular trips out and several people said they had enjoyed a trip to the New Forest the previous day.
Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 15 The activity organiser gets feedback about activities from unit meetings, staff, residents and relatives. In the specialist care unit, the staff were considering where to site the orientation board to give the residents information on date, weather, activities and daily the menu. Some residents from specialist unit go to 1st floor to join activities there if appropriate. Units were known as lane, crescent etc so each resident has a proper address. The home had opened a shop and was run by the residents. Other activities included: • Poetry readings • Armchair travel club, where staff give a talk on their country of origin. Residents attending have a passport, which is stamped. • Shop, residents help run it. • Musical entertainment. • Activities pack available for those who prefer their own company. People in the home are added to the electoral register so that they can remain involved in the democratic process if they wish. Religious services are offered in the home weekly and communion is available once a month. Spiritual needs are considered during the admission process and the home contacts relevant faith leaders to meet all needs. Generally the residents seen were positive about the food provided and this was also the overall impression from the residents comment cards, however one person commented that the food is sometimes good and sometimes awful and was often not left with a menu. Another said they would like more choice. One relative commented that the food was excellent. The AQAA stated that menus were discussed at resident meetings and there was always a choice of three hot and one cold main meals. Breakfast was served at times to suit the residents and a cooked breakfast offered on a Sunday. At teatime a hot meal or sandwiches were offered and snacks were also offered at suppertime. Drinks were regularly offered and available throughout the day and night. As previously mentioned nutritional monitoring was routinely carried out. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s systems allow concerns to be raised without fear of recrimination. EVIDENCE: The home had a very clear policy and procedure, which was followed by the home. The information is available in the pack given to each resident on admission. Since the last inspection, a number of issues had been forwarded to the Commission. The action taken by the home following these issues has been appropriate and efforts taken to address any problems. A record of seven complaints were reviewed and all were fully documented and investigated as per policy. The home also retained copies of the many compliment received from visitors to the home. All staff were recruited following relevant checks of Adult Protection register and suitable Criminal Records Bureau checks. Staff were trained in responding to allegations or signs of abuse. The staff seen during the visit were aware of their responsibilities. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 17 The AQAA identifies that the homes complaint system is a method used to understand issues raised by stakeholders and that will lead to further improvements. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home offers a high standard of accommodation which allows residents good opportunities to maintain their mobility. The home was clean and warm and the staff were trained in infection control to reduce the risk of cross infection. EVIDENCE: The home had been opened for a year and remains able to offer extremely high levels of accommodation with a good supply of aids and adaptations to help residents independence. The rooms seen had been personalised by the occupants. It was noted that rooms were not provided with disposable hand towels and soap dispensers the matter was drawn to Mrs Elliott’s attention and
Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 19 the matter was attended to immediately with half the rooms provided with the items by the third day and the other were being installed by a contractor. The rooms were fitted with call alarms allowing the occupant to call for assistance if needed. In the rooms visited, all were located within reach of the occupant. One person did comment that sometimes staff took a long time to respond to the calls. Mrs Elliott stated that following the last inspection a call logging device had been provided to monitor the call alarm response times this enabled staffing levels to be effectively monitored. She was clear that response times were improving and the situation would continue to be monitored to ensure that staffing levels were appropriate. The AQAA states that staff receive training on infection control during their initial training they also complete a 12 week distance learning module on the subject. The home has its own laundry area equipped with commercial washers and dryers, it is sited away from food preparation and storage areas. The home had recently completed a Department of Health audit for infection control. A number of hoists were seen around the home all had been serviced by a contractor. All areas of the home were warm and clean. One cleaner said that the staffing roster ensure that there were cleaners working each day and that the domestic staff had received infection control training. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was adequately staff at the time of the inspection. The staffing team were developing the required skills and were generally well trained. The home’s recruitment practice helped to ensure the suitability of those offered employment. EVIDENCE: The home had seen a slight increase in the number of agency staff used to cover vacant shifts it remained at less than 10 of the total staff hours. A complaint received by the Commission identified significant staffing problems during August, this had been addressed. However, comment cards responses showed that concerns still lingered from residents relatives, care managers and staff • Staffing roster problems 21:30-22:00. • Changeovers fragmented leading to inconsistency. • Staff absence – sickness high levels. • Not able to fill with agency staff – new system being introduced. • Magnificent- everyone does a marvellous job, grateful to everyone for what they do. • Nearly all of the staff are very good- just one or two not quite so sure.
Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 21 Sometimes there is a shortage of staff especially in the afternoons and weekends • Very occasionally on change over about mid afternoon it is difficult to find a staff member on a specific unit –have to go to another unit • More staff in the NH unit high needs almost require one to one. • Should improve staff ratio – there are never enough staff on the first floor. These points were discussed during the meeting and Mrs Elliott was sure that many of the problems quoted related to a particular period in the summer which was being resolved. A report of call bells responses to one resident did show some evidence of trends however there was no apparent evidence of delays in response to the calls although the report did not easily identify call response times.
• A staffing roster was seen and there was a record of actual hours worked by individuals. The roster clearly indicated that there were normally both shifts on duty in the handover between shifts however there was an occasion when a member of staff did not turn up leaving two carers to cover the floor. Since the last inspection, the home had recruited a second deputy manager although there had been delays in releasing her and the other deputy from some of their “hands on” roles. The new structure was to help the whole service develop and to allow for appropriate management time for a home of the size and complexity. In terms of recruitment, several files were checked. There was clear evidence that people were offered a position once the organisation was satisfied with the required references and clearances. One file was not clear whether the individual had employment elsewhere. Four staff recruitment files were reviewed and they contained: • Completed application forms • Two written references • Enhanced CRB and POVA first checks • Terms and conditions of employments • Documentary evidence of any relevant qualifications • Proof of identity, including a photograph. Training files demonstrated that staff were receiving induction training and this was confirmed with staff spoken with during the inspection. Training included: • Basic food hygiene • Emergency life support
Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 22 • • • • • Fire safety MDS training from Boots Tissue viability Dementia care Mental capacity act. As stated earlier, the home had not started Palliative care training however, this was planned for the new year and the Commission was advised that some work had already started to improve the staffs knowledge and understanding. Several staff commented that the standard of training was very good and they were able to identify their training needs through the supervision process and annual appraisal. The home has monthly unit meetings allowing staff to discuss ideas and concerns. Some commented that they had originally moved on rotation between units, however it was found that this was not good for continuity of care and they were now allocated to a particular unit. The AQAA stated that there was a training record for each member of staff with a programme continually being reviewed for ongoing training. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Changes to the management structure should help to ensure the home has adequate management support for the size of home. The home has good systems to ensure the views of those involved with the home are listened to and acted on. The home’s safety systems help to keep the residents and staff safe. EVIDENCE: Mrs Elliott has the experience and qualification required to run the home effectively. She is developing a senior team that should be able to address the
Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 24 ongoing issues which have beset the home in its first year. She continues to manage her own personal development and had recently attended a conference on Dementia to maintain her knowledge. Since the last inspection, the staff have been providing the Commission with notifications of significant events in the home. The Authority undertook a quality assurance exercise with stakeholders and the findings used to help develop the improvement plans. The residents and staff had clear routes to raise concerns and general issues and several commented that their views were listened to. It was clear from the inspection visit that the manager took action immediately to address shortcomings. In addition to the QA exercise the Authority had also completed an internal audit of the home to help identify where improvements could be made. Residents’ finances and personal allowances were not considered at this inspection, no concerns or issues regarding finances were raised through the comment card, complaints log or the AQAA. As stated previously the home had arranged for paper towels and soap dispensers to be installed in all the residents’ rooms to improve infection control procedures. These items had already been provided in the sluice rooms. Fire records were checked and there was evidence that all staff had received regular fire safety training. Fire fighting equipment was routinely tested and were also serviced by contractors. Approved contractors had also serviced hoists and other lifting equipment. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 3 Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP27 OP28 Good Practice Recommendations Care plans should contain relevant and current information to ensure staff are clear how those needs are to be met. The home should continue to monitor that the service is appropriately staffed to meet the needs of the residents. The employment status of successful applicants should be checked to ensure that staff are not working excessive cumulative hours at different workplaces. Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Avon View Residential & Nursing Home DS0000068173.V354977.R01.S.doc Version 5.2 Page 28 - 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!
