Inspection on 25/11/08 for Avon View Residential & Nursing Home

This inspection was carried out on 25th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Avon View Residential & Nursing... 20/05/09

Avon View Residential & Nursing... 15/11/07

Avon View Residential & Nursing... 31/01/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avon View Residential & Nursing Home Loring Road Christchurch Dorset BH23 2GZ     The quality rating for this care home is:   zero star poor 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: Amanda Porter     Date: 0 1 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 29 Information about the care home Name of care home: Address: Avon View Residential & Nursing Home Loring Road Christchurch Dorset BH23 2GZ 01202485170 01202482280 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Amanda Mary Elliott Type of registration: Number of places registered: Dorset County Council care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. 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. Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 29 Over 65 20 50 0 0 0 10 Brief description of the care home 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 462 pounds - 565 poundsfor nursing places. Additional charges were made for hairdressing, chiropody, etc. See the following website for further guidance on fees and contracts: /www.csci.org.uk/about_csci/press_releases/better_advice_for_people_choos.aspx Care Homes for Older People Page 5 of 29 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: zero star poor 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: The quality rating for this service is 0 star. this means the people who use this service experience poor quality outcomes. This was a statutory inspection required in accordance with the Care Standards Act 2000. This inspection was carried out by two inspectors, and thoughout the report the term we is used, to show that the report is the view of the Commission for Social Care Inspection. This inspection was unannounced, the inspectors arrived at 9:15am on the 25th Care Homes for Older People Page 6 of 29 November 2008, toured the premises, spoke to residents, visitors and staff, observed staff interaction with residents and the carrying out of routine tasks and discussed and examined documents regarding care provission and management of the home. The duration of the inspection was 7 hours. During this inspection compliance with all key standards of the National Minimum Standards were assessed. 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.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 8 of 29 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 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is unable to guarantee that the needs of all new residents can be met because some assessments are not sufficiently thorough. Evidence: We reviewed the pre-admission documentation for five new residents. The assessments for two people on the nursing unit were thorough and informative. Others lacked some detail, which included medical information that was relevant to the prospective residents well-being. We spoke with people on the intermediate care unit who told us that the staff and facilities were helping them become more independent. One person told us You couldnt ask for anything better. People also told us that before moving into the home they had been visited by the manager or one of her deputies and their admission had been fully discussed. Care Homes for Older People Page 10 of 29 Care Homes for Older People Page 11 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents generally receive the care they need but staff do not always respond appropriately to changing needs and care records do not provide sufficient guidance and information to staff to enable them to properly care for the residents. The safe medication processes within Avon View ensure that the people living there have the medication they need. Evidence: We reviewed the care records for eight residents. The standard of recording and care planning was variable. On the nursing unit the standard of care documentation had much improved since the last key inspection. Policies and procedures had been reviewed and were based on best practice. However in reviewing one care file we were made aware of a situation where a resident threatened harm to himself and others. There was no evidence that appropriate medical help was immediately forthcoming. On the residential unit the care documentation was generally well completed. However there were still some Care Homes for Older People Page 12 of 29 Evidence: shortfalls in recording. One resident was unwell with a suspected chest infection and there was no care plan relating to this. Nutritional screening forms were seen to be incomplete in some files. We reviewed the care documentation on the intermediate unit and found that generally staff had the information they needed to be able to give a good level of care. However there were still some shortfalls in recording and the care plans lacked detail about certain aspects of personal care. One resident was having creams applied but there was no information about what cream was used or why. These shortfalls in documentation may result in residents receiving insufficient or inappropriate care. We spoke with people living on these units and they told us that they were well looked after by competent, caring staff. On the dementia care unit we reviewed records for two people which provided evidence that although these people had, on various occasions, frightened and harmed other residents the care plans had not been reviewed to reflect the increasing behavioural issues.There was insufficient evidence that all accidents to residents were thoroughly investigated with findings reflected in care plans, to ensure that future risks were minimised. The home did not have a policy on restraint although various methods of restraint, such as the use of bed rails, pressure mats and cocoons, were used. Although consent had been obtained from a family member for there use there was no clear risk assessment or rationale for their use. Since the inspection the home has produced a policy and risk assessments. The home had a good medicines policy and procedure in place. Examination of records indicated that medicines were properly administered so that residents were assured that they would get the correct medication they needed in accordance with their GPs instructions. We looked at the medication administration records and found that these were being completed correctly with no gaps within the records. Care Homes for Older People Page 13 of 29 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. Residents have opportunities to engage in social and recreational activities and are encouraged and supported to pass the time according to individual preference. A choice of menu is provided and meals are nutritional and appetising. Evidence: The home continues to provide a range of social, religious and recreational support to people living there. People told us that they were happy with the lifestyle that living at the home afforded them. Some chose to spend time on their own but knew they could join in with any organised activities if they so wished. The home has recently employed a third activities organiser, which has increased the availability of activities to everyone living at Avon View. Activities included gentle exercise classes; outings to local places of interest; musical entertainment; art and crafts. There is a religious service held at the home each week. Residents said that they could entertain their visitors in private and that they were always made very welcome. People told us that they were free to choose whether they wanted to handle their own Care Homes for Older People Page 14 of 29 Evidence: financial affairs. Some preferred to have a family member to act on their behalf. All residents spoken with confirmed they enjoyed the food provided. Records showed that residents likes and dislikes with regard to food were known and residents were aware that alternatives to the main menu were always available. Care Homes for Older People Page 15 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has failed to properly protect frail and vulnerable residents from risks of harm and injury presented by other residents. Evidence: Residents told us that they knew how to complain and felt confident that if they had concerns or complaints they will be listened to and taken seriously. In the annual quality assurance assessment submitted by the home to the Commission the home stated that they were following the new guidelines regarding the reporting of potential POVA (protection of vulnerable adults) cases. This was evidently not the case as there have been a number of recent occasions when residents have been distressed, frightened, placed at risk of harm and sometimes actually injured by the behaviour of other residents. Most of these incidents have not been reported to us, although this is a requirement of registration. There is insufficient evidence that staff have properly protected residents from risks of harm posed by other residents. Care records do not provide staff with appropriate guidance on managing challenging behaviour and following each incident there has not been investigation or care review, designed to minimise recurrence. The home did not have a policy with regard to restraint. However methods of restraint, such as the use of cocoons, bedrails and pressure mats were being used. Consent had Care Homes for Older People Page 16 of 29 Evidence: been sought from a next of kin but where restraint was used appropriate risk assessments had not been undertaken. Since the inspection the registered manager has confirmed that a policy is now in place and risk assessments are now being undertaken. Care Homes for Older People Page 17 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment at Avon View is excellent providing residents with an attractive and homely place to live. Evidence: We toured the premises and reviewed the maintenance documentation, which showed the home was well maintained inside and out. There was evidence that equipment was serviced regularly. People living in the home had easy access to all communal areas.Residents rooms were of a good size and furnished appropriately. Bedrooms were personalised with a variety of mementos, pictures and small items of furniture.All areas of the home seen during the inspection were clean, bright and free from any unpleasant odours. People told us that the home was always kept clean. The AQAA told us the home has a variety of general specialist equipment, hoist, height adjusted beds and indiviual residents were supplied with the correct equipment to meet their needs on admission to the home and this was regularly reviewed by an occupational therapist. Staff were trained in infection control. The laundry continued to be well managed. Adequate supplies of clean linen were seen Care Homes for Older People Page 18 of 29 Evidence: to be available. Care Homes for Older People Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate numbers of staff are employed to work at Avon View and recruitment practices make sure people are kept safe. However training within the home is not sufficient to enable staff to meet the needs of residents on the dementia unit. Evidence: The random inspection, which took place on the 16th October 2008, identified that the home was short of staff at times. Since then Mrs Elliott has given us assurances that staffing hours have improved.This includes extra staffing hours on the intermediate care unit, dementia and residential unit. A third person has been employed to join the activities team. People living, visiting and working at the home said the home was now staffed well and residents were not kept waiting. Two staff recruitment files were reviewed. The files were well ordered and contained all the information required by law. POVA first and enhanced Criminal Record Bureau checks had been obtained for all new staff. Mrs Elliott has told us that 55 per cent of the care staff have obtained NVQ in care at level 2 or above, which means that the majority of people living at the home receive care from someone with the appropriate skills. People told us that they thought that Care Homes for Older People Page 20 of 29 Evidence: staff were competent, kind and caring. However training files demonstrated that not all staff were receiving sufficient or effective training in caring for people with dementia and dealing with challenging behaviour. The number and nature of incidents of aggression and abusive behaviour that the home had recorded indicated that not all staff had a good knowledge or appropriate skills in delivering person centred care, which may have reduced the number of such occurences. The activities organisers in the home had not received any specific training in caring for people with dementia. Such training may provide them with the skills to provide suitable activities for people with dementia. Staff told us that there were good training opportunities generally and that they were encouraged to attend. Recent training had included induction, moving and handling, first aid, food hygiene and palliative care. Care Homes for Older People Page 21 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are currently occasions when lines of communication and responsibility in the home do not clearly protect and promote the welfare of people living in the home. The responsible individual has failed to reliably monitor the operation of the home and prior to the inspection had not identified the many weaknesses identified in this report. Evidence: Mrs Elliott has the experience an qualification required to run the home effectively. she continues to manage her own personal development. The home has a quality assurance system in place including questionnaires sent to residents and visitors to the home. Resident and staff meetings are held and minuted. However the provider organisation has failed to adequately monitor the performance of the home; regular visits by representatives of the organisation have taken place but had not identified the weaknesses described in this report. There have been a number of occasions when particular residents have placed others at risk of harm or injury and the home has failed to properly protect and safeguard the people accommodated. Care Homes for Older People Page 22 of 29 Evidence: The Registered Manager confirmed that the home held a small amount of money for residents if they so wished. Records showed that all such monies were accounted for. Records showed that staff had received recent training in fire safety and manual handling updates. Staff spoken with confirmed this. Records showed that equipment had been serviced regularly. We reviewed a number of accident and incident forms. The home was unable to provide robust evidence that appropriate action was taken following a number of episodes where certain residents were physically aggressive. The home had also failed to notify us of all events which affect the wellbeing of people living and working there. The safety and well being of some residents was compromised where methods of restraint were used without the appropriate risk assessments being carried out. Care Homes for Older People Page 23 of 29 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 24 of 29 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 3 14 The registered person must not provide accommodation to a resident at the care home unless, so far as it shall have been practicable to do so Needs of the resident must be assessed by a suitably qualified or suitably trained person and kept under review. To ensure the home will be able to meet the persons needs when they arrive in the home. 25/02/2009 2 7 15 The registered person shall, 25/02/2009 after consultation with the service user, or a representative of the service user, prepare a written plan (the service users care plan) as to how the service users needs in respect of health and welfare are to be met, Care Homes for Older People Page 25 of 29 and shall keep the plan under review. Care plans and other care recors must be improved to ensure of accurate information to staff to enable them to properly care for residents. 3 8 12 The Registered Person must 25/02/2009 ensure that the home promotes and makes proper provision for the health and welfare of residents. Risk assessments must be kept under review and completed correctly. This must include nutrtional screening. Where care needs are identified the appropriate care is given to the resident. This will ensure that any risk assessments undertaken will highlight any areas of concern and appropriate action can then be taken by staff. 4 18 13 The registered person shall make arrangements, by training staff or by other measure, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. To safegaurd residents from harm. 5 30 18 The registered person must ensure that the persons employed by the registered person to work at the care 25/02/2009 26/01/2009 Care Homes for Older People Page 26 of 29 home receive training appropriate to work they are to perform. Staff with a knowledge of person centred care will be able to support residents on the dementia unit in a more effective way. 6 33 24 The registered person must 25/02/2009 maintain a system for evaluating the quality of the services provided at the care home, which must include a system of internal audits. This will identify any shortfalls in the service provided and improvements can me made in a timely fashion. 7 37 37 The registered person shall 25/01/2009 give notice to the Commission without delay of the occurrence of any event in the care home which adversely affects the well being or safety of any service user. To comply with registration regulations. 8 38 13 The registered person shall 25/02/2009 ensure that no service user is subject to physical restraint unless restraint of the the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. Care Homes for Older People Page 27 of 29 This is to ensure the safety and wellbeing of residents. 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 28 of 29 Helpline: 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 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 © (2008) 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 29 of 29 - 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. 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