Inspection on 31/01/07 for Avon View Residential & Nursing Home

This inspection was carried out on 31st January 2007.

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

The inspector 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 View Residential & Nursing... 20/05/09

Avon View Residential & Nursing... 25/11/08

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

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

CARE HOMES FOR OLDER PEOPLE Avon View Residential & Nursing Home Loring Road Christchurch Dorset BH23 2GZ Lead Inspector Trevor Julian Unannounced Inspection 31st January 2007 10:00 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.V329114.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.V329114.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 482280 01202 485170 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.V329114.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. New Service 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 2005 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 January 2007, the weekly fees were set at £417. 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.V329114.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over four visits between 31st January – March 2007. The lead inspector, Trevor Julian, was assisted by Amanda Porter and medication procedures were inspected by Christine Main, Pharmacy Inspector. Before the inspection, the manager had returned a pre-inspection questionnaire giving basic information on the care needs and management of the home. Residents, visitors and healthcare professionals were consulted though surveys. There were responses from 28 residents, 20 relatives, 6 GPs and 8 healthcare professionals. During the inspection discussions took place with the residents, staff, visitors and management. Records were examined and there was a tour of the premises. A total of hours were spent on site 30 hours. What the service does well: This was the first visit to the home since residents transferred from the old building. The impression gained was that while there had been considerable improvements in the standard of accommodation the overall service was still “bedding in” as the staff team were gaining experience and improving. No resident was admitted to the home without a pre admission assessment to ensure that the assessed needs can be met within the home. Each resident had a care plan to inform staff how identified needs were to be met. Storage provided for medication was good. Most medicines are supplied in monitored dose blister packs, which allow easier monitoring, and Medicine Administration Record (MAR) chart printed by the pharmacy included medicine allergies. Residents described the staff as kind, caring and supportive. The home held regular meetings with residents to consider the activities available and other issues affecting their daily lives. There had been a second activity organiser appointed to allow the programme to be developed and extended. Food was served in the dining areas of each floor from heated trolleys. People felt there was a good level of choice and second helping were offered, one visitor volunteered that they felt there could be more fresh fruit available. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 6 The home had a complaint procedure accessible to the residents and visitors. Residents said they were able to raise concerns directly with the management and staff without making a formal approach. There had been improvements in managing allegations of abuse and new staff were given training on how to respond. As a new building the home offers excellent levels of accommodation which promotes independence and dignity for the residents. There were a high ratio of adjustable beds which residents described as very comfortable and assisted the staff when providing care. To the rear of the property there was a secure garden and one resident was selecting and planting the raised flower beds. The training programme was good and the staff working on the dementia unit were receiving specialist training. The management team had the skills, qualifications and experience to run the home and the residents felt comfortable with them allowing them to raise concerns. There were systems in place for seeking the views of the residents and they were in the process of completing an annual survey, the results would be used to develop an improvement plan. The home did not directly manage finances for any of the residents. Some deposited personal allowances with the office staff for personal expenditure e.g. hairdressing, chiropody etc. The records and balances were not check during this visit. What has improved since the last inspection? What they could do better: The care plans and records should show the action taken and the outcome; they should provide evidence that the resident or their representative had been involved in the process. The home needs to have systems to improve medication records and ensure that medicines are given as prescribed. Access to rear garden is good for the residents living on the ground floor however; others complain that access to the gardens is difficult. The manager was working with the residents to improve the situation. It was found during recent Adult Protection meeting that some significant incidents had not been reported; this has improved. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 7 Doors marked “fire door keep locked” were unlocked. This included the sluices and linen store rooms. Resident records and cleaning equipment was held in the kitchen areas in unlocked cupboards this had been addressed by second visit. The staff reported the call alarm system was unreliable and the pagers difficult to read. There was no management system to identify the speed of response. There were reports of delays in responding to calls. Staff on duty in the evenings reported that “out of office” hours the incoming telephone line was transferred to a mobile telephone so when calls come into the home staff have to take the phone to the called person who could be anywhere in the building. The front door bell goes to the pager system and staff have to go to the front door to let people in and out. With lighter evenings they are concerned that they will be up and down stairs and away from their care tasks. Staffing levels at nighttime particularly in the dementia units were insufficient and placed the residents and staff in vulnerable position. The home has grown and increased the registration categories and added a 25 bedded nursing unit. The deputy manager had a number of managerial tasks additional to her nursing role. With the size and scope of services, sufficient supernumery time should be available to ensure the home is managed effectively. 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.V329114.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.V329114.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. Pre - admission assessments were completed to ensure that the needs of prospective residents can be met within the home. Intermediate care offered in the home helps the residents to return to independent living. EVIDENCE: Care files for six residents were seen and each contained a pre-admission assessment, which provided sufficient information so that a plan of care could be drawn up. Each file also contained a copy of a community care plan. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 10 Intermediate care was provided in a purpose built unit within the home. The unit was well equipped with a large treatment room, where support could be provided through input from occupational therapists, physiotherapists and the community nursing team. Avon View Residential & Nursing Home DS0000068173.V329114.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. The care plans were not always up to date and the information provided was not followed through. Care needs were addressed through working with healthcare professionals. The home has systems in place for managing residents’ medicines but some aspects need improving to safeguard residents’ health and wellbeing. The people living at Avon View were treated with dignity and respect to ensure that the residents’ basic rights were upheld. EVIDENCE: The files seen, each contained care plans and information for the staff about how needs were to be met. There was evidence of monthly reviews of care Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 12 need and weight checks. Some lack detail e.g. one resident was deaf in right ear and wore a hearing aid in the left, essential for effective communication. A relative of the resident had provided the staff with a written summary of the resident’s needs stating how important this was. The care plan written by staff did not indicate which ear the hearing aid went in. The home had introduced a falls chart for residents to monitor frequency and causation of falls in the home. One file showed 6 falls over a six week period however, the recorded information was incomplete and did not allow useful analysis. The person’s care records identified another fall which was missed from the falls chart. There was an inconsistent approach to identifying social care needs. On some files, social care needs were not assessed and therefore there were no care plans to tell staff how these needs were to be met. Other files showed that the topic was covered with personal histories. Files contained: • Informative moving and handling plans. • Body mapping charts. • Records of GP and health professionals visits. • The residents admission/discharge check list, which made clear the preferences for daily living, such as whether the resident wanted a key to his door; bathing preferences; mobility aids used; a brief summary of dietary needs. The daily records seen showed there was a lack of continuity with issues noted and then no further information about the action taken. There was very little review or mention of mental state/wellbeing in the daily records. Comments were received that the staff were not always clear about why GP’s had been called to the home, possibly caused by a lack of communication between staff. In the nursing unit there was little assessment for nutrition or the risk of pressure sores. During one of the adult protection investigations, it was established that the recording of timing of incidents was not always accurate. It did not appear that residents/relatives were involved in the drawing up and review of care plans. However, one visitor to the unit felt that he was kept informed on his relative’s condition “The care is very good and staff are kind and caring.” Another resident said she was happy with the care. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 13 Interaction between residents and staff was observed and there was a relaxed and happy atmosphere. Comments from residents included “The staff have plenty of patience.” “The staff always do their best”. On the intermediate care unit two files were seen one contained a very informative care plan, which was updated frequently and fresh goals were set. One resident spoken with was full of praise for the care and attention from the staff “This place is fantastic” The medication policy on the nursing unit was written for a residential home rather than nursing. The unit is disposing of medication correctly (Doop sets) but this is not included in policy. There is guidance for nurses to follow which includes CSCI guidance and NMC guidelines for the administration of medicines. On 14/03/07 the pharmacist inspector was told that the policy was being reviewed and updated and saw additional local policies that matron had written to improve recording warfarin and new medication received in the home. When hand written Medicine Administration Record (MAR) charts were used the were not always signed and countersigned as checked for accuracy. On one MAR chart it appeared that some eye drops had not been given because of lack of stock but the deputy manager felt the GP had stopped them. This information was not made clear on the chart. A check of medication for a new resident identified that the audit trail was not accurate with two doses missed without explanation. The home uses a monitored dosage system for the administration of medication. Some of the new members of staff were still getting used to the system and the home had arranged for additional training from the supplying chemist. The records did contain photographs of the residents to aid identification. On the nursing unit following this training the pharmacist inspector’s checked two residents’ medication and it agreed with the records indicating that it was given as prescribed. The doctor had reduced one resident’s analgesic dose without explanation and the deputy manager agreed to confirm this. The resident said she was comfortable and not in pain. Records of administering medication on residential units were incomplete. For example there were 8 gaps on one resident’s MAR chart where staff had not signed medicines as given, or recorded a code letter for the reason they were not given. The audit trail for medicines in blister packs indicated that they were given as prescribed. But for three medicines supplied in bottles or packets the number of tablets remaining did not agree with the number expected from the records indicating that they were not given as prescribed and / or not recorded Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 14 correctly. For some others there was no means of checking whether they were given correctly as the date of starting a new pack or the quantity carried forward from the previous MAR chart was not recorded. There was no system for checking medication records and audit trails to ensure that residents’ medication was given as prescribed. Tests for monitoring residents’ medication were not always followed up. For example the dose change for one resident was not updated on the MAR chart when new instructions were received the previous day. Staff addressed this straight away. Some residents on the rehabilitation unit self-medicate. Lockable storage is provided but one resident was not using it and the risk assessment needed reviewing to reflect this. All medication was stored securely and balances recorded in CD registers were correct. Medicine fridges were not correctly monitored by recording the maximum and minimum temperatures and resetting the thermometer daily to ensure that temperature sensitive medication was stored at the correct temperature to maintain its effectiveness. Two residents’ eye drops were dispensed more than 4 weeks ago and the date of opening had not been recorded so that they could be replaced after 4 weeks to prevent infection. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 15 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. Residents were encouraged to make choices regarding their preferred social and religious preferences. The home sought the views of the residents in order to provide appropriate activities. Visitors were welcomed into the home at any time. The food offered a good range of choice and the surroundings and support available helped to encourage a good diet. EVIDENCE: There were notices around the home inviting residents to a residents’ meeting. The inspector was invited to join the group. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 16 The residents said that the home held regular meetings and there were minutes and outcomes from action points. People were actively discussing daily issues and activities. Most residents spoken with said that they were “free to make decisions about how they spent their days” and they were happy with the lifestyle that living at Avon View afforded them. Some chose to spend time on their own but knew they could join in with any organised activities. There was a programme of activities drawn up by the activities organiser, these included: • Musical entertainers. • Quizzes. • News and current affairs. • One to one sessions. The activities were not necessarily based on the assessed needs of the residents, as such assessments had not been undertaken. The activities organiser was very stretched at the first visit. However, another appointment has been made and a second activities person had started work between the inspection dates. Residents confirmed that their visitors were always made welcome at the home and they could have visits in private. Residents spoken with at the time of inspection said that they generally enjoyed the food provided. One relative said that there could be more fruit on the menu. Others commented that there was a good selection of food and there was always enough with second helpings available. Food was served in the dining areas on each of the units. Food is served from heated trolleys. Residents and staff said the food was kept warm and well presented. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 17 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. Systems were developed to allow complaints to be raised and investigated without recrimination. Adult protection procedures had been improved to ensure that signs and allegations of abuse are correctly addressed. EVIDENCE: Information was readily available to residents and visitors about how to raise concerns and complaints. The residents’ meetings were also used to get general feedback from the residents. Residents commented that the staff and management were approachable and dealt with any issues as they arose. The Commission had received no concerns and complaints about the service. The staff were trained in responding to allegations or signs of abuse. The home had arranged for an Adult Protection co-ordinator to visit the home at a future staff meeting were the topic would be discussed. Staff seen were aware of their responsibilities. There had been two notifications to the Commission of allegations of abuse during the investigations it was found that other incidents had not been properly and independently reviewed. This matter had been subsequently addressed. Avon View Residential & Nursing Home DS0000068173.V329114.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, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new home provides an excellent standard of accommodation. Although, ongoing “snagging” problems were creating difficulties for the staff. The home provides a clean and comfortable environment with good infection control procedure. EVIDENCE: Each floor consisted of 2 large lounges with dining areas and up to 25 rooms. Each bedroom had an en-suite with shower. The rooms were large enough to be able to use manual handling equipment safely and a proportion of the bedrooms had overhead hoists. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 19 The nursing unit is made up of a small area for respite beds, Oak unit and Willow. Only 8 of the bedrooms were being used at the time of inspection therefore only Oak was being used. All areas seen were well equipped, warm, clean and fresh. In addition to the individual showers there was an assisted bath provided on each floor to provide flexibility and choice. Residents said they could ask for a bath when they wanted and the records also showed that some people declined the offer. Residents described their beds as very comfortable. There were a significant number of adjustable beds in use to aid staff and residents. Sluices were available on each floor the doors to the sluices and other cupboards were signed “Fire Door Keep Locked” during the tour of the premises many of these doors were unlocked and in the case of the specialist dementia unit this could pose significant risks to the residents. The laundry was sited away from food storage and preparation areas. Each room had a call alarm fitted linked to a control panel and pagers. Several comment cards identified that the calls were not promptly answered. In discussion with staff the system had been unreliable and the pagers were often returned for repair. There was no management system to monitor the speed of response. There were also problems with the telephone line being transferred to a cordless phone once the reception staff finished work; calls could not be transferred to other areas of the home so the senior member of staff was required to carry the phone to the required location in the home. Similar problems were encountered when visitors rang the front door for access. These issues have a direct impact on the staff and their ability to provide care. The secure garden at the rear of the property is accessible form the specialist unit with some of the residents from the other floors needing to be escorted the garden has become less accessible. This had caused concern to a number of residents and the manager was working with them to solve the problem. One resident had been planting the raised flower beds and his handiwork was beginning to show results. Avon View Residential & Nursing Home DS0000068173.V329114.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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels did not take account the level of care and could place residents and staff at risk. The training programme would ensure that the staff had the skills and training to deliver a good level of care. The recruitment process was not robust and could result in unsuitable staff being employed. EVIDENCE: The home was generally well staffed however there was evidence from comment cards that calls were unanswered at certain times of the day. The two dementia units were staffed by 4 during the day and 2 at night, one per unit. They are able to contact other members of staff using the hand held “two way radios” however, this ratio must be regularly reviewed to ensure that as needs change they are correctly staffed. The deputy manager was responsible for organising training; all new care staff have the “skills for care” induction. Staff were booked to go on a four day Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 21 induction away from the home and this induction would include manual handling. This training is not always delivered on commencement of employment and staff may have to wait several weeks before attending. Staff working in the specialist unit had received training in Dementia. The deputy manager was also responsible for the delivery of fire safety training and a session was delivered during one of the visits. Registered nurses have been able to attend: • Syringe driver update • Diabetes update. A medication update took place in February. Staff will be able to join MacMillan services training when it is restarted. This is essential if the unit wishes to accommodate residents with palliative care needs. The unit should also need a policy for palliative care. One RN spoken with said that she enjoyed working at the home. She had experience of working in a care home and she feels well supported by her colleagues. She was awaiting induction training but has been working at home since about October. Recruitment files were seen for several members of staff and each contained the relevant basic information. Other files showed that the applicants had not always supplied full employment histories not had the interviewer explored the gaps. All files had evidence of Criminal Records Bureau checks. Staff said the home was developing and many were still gaining experience. The manager and senior staff were accessible. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 22 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was generally well managed but the nursing unit had insufficient dedicated management time. The home was continuing to develop the quality assurance systems. Systems were in place to protect residents from financial abuse. Health and safety within the home needs to be better managed to ensure the safety of residents and staff. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home’s management team have the qualifications and experience to manage the home effectively. Nevertheless, the home was still developing and there were identified issues to be addressed. As a very large service, the management time allocation was inadequate with the deputy manager given a range of management tasks and also working shifts in the nursing unit. As stated previously there had been adult protection investigations and these had identified that the home had not always reported untoward incidents to the commission following the investigations the reporting process had greatly improved. The Authority had a system of monthly visits to the home by senior staff to ensure that standards were being maintained, the reports were provided to the manager of the home and the Commission. The home seeks the views of the residents and visitors regularly; there was a survey underway which would be used to inform the business development plan. The home did not directly manage the finances of any of the residents some people deposited cash with the home for personal expenditure e.g. hairdressing etc. the records were not examined during this visit. During the first day of inspection, residents’ records were not held securely by the time of the second visit locks had been fitted and the records securely held. Residents said they were aware that the home maintained records but no one had asked to see their own records. A fire risk assessment had been completed and the staff were trained in fire safety. There were plans to carry out a fire drill. A competent person had inspected the lifts and hoists. Portable appliances were being visually checked. There was a Control of Substances Hazardous to Health file. During the first visit, cleaning material was stored in cupboards in the kitchen areas on the units and this presented a hazard to the residents. This was addressed by the time of the second visit. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 24 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 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 3 2 Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? New Service STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Timescale for action 30/04/07 2 OP29 19 3 OP31 18(1) 1. The Registered Person must make arrangements for the recording, and safe administration of medicines received in the care home including: Ensuring that medicines are recorded at the time they are given and monitoring medication records and audit trails to ensure that medication is administered as prescribed and accurately recorded to meet residents’ healthcare needs. The registered manager must 30/04/07 ensure that gaps in employment history are fully explained before being offered a position. The registered provider must 30/04/07 ensure the home is adequately staffed. The management team must be given sufficient supernummary time to ensure the service is managed correctly. Avon View Residential & Nursing Home DS0000068173.V329114.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP7 Good Practice Recommendations The care plans should be developed to include social needs to ensure that planned activities are appropriate. The care records should demonstrate the action taken to identified issues. • Falls charts should contain sufficient detail to allow useful analysis. • Where needed times of events and incident should be accurately recorded. The home should follow guidance from the Royal Pharmaceutical Society including: a) Recording the date of opening eye drops so that they can be discarded after 4 weeks to prevent infection. b) Monitoring and recording the maximum and minimum temperature (normal range 2-8°C) of the refrigerator used to store medicines daily when in use. c) When handwritten entries are made on the medication administration record, they should be checked for errors by a second person. There should be a review of the call alarm system to ensure that the system is correctly configured in order to identify the source of the calls. The telephone system and doorbell should be reviewed to ensure that the systems are manageable out of office hours. The manager should ensure that areas of the home are secure and do not pose unnecessary risks to residents. 3 OP9 4 OP22 5 OP38 Avon View Residential & Nursing Home DS0000068173.V329114.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.V329114.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. 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