Inspection on 11/09/07 for Avondale Nursing Home

This inspection was carried out on 11th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Avondale Nursing Home 06/07/06

Avondale Nursing Home 19/01/06

Avondale Nursing Home 22/06/05

Avondale Nursing Home 16/11/04

Avondale Nursing Home 21/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Avondale Nursing Home 26 Snakes Lane West Woodford Green Essex IG8 0BS Lead Inspector Julie Legg Unannounced Inspection 09:30a 11 -17 September 2007 th th 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 Avondale Nursing Home DS0000025947.V350696.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. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avondale Nursing Home Address 26 Snakes Lane West Woodford Green Essex IG8 0BS 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) 0208 506 2194 0208 559 0251 Mrs Inderjeet Kaur Ford Ms Elizabeth Ruth Polkinhorn Ms Elizabeth Ruth Polkinhorn Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2006 Brief Description of the Service: Avondale Nursing Home is a 20-place care home with nursing for older people situated in a residential part of Woodford. The accommodation is comprised of a two storey detached house with purpose built extensions to the side and rear. There is car parking to the front of the house, a small patio area to one side, and a garden to the rear. There are two connecting lounges on the ground floor, along with a utility room, kitchen, staff office, and some bedrooms. The remaining bedrooms are on the upper floor, along with bathrooms and toilets. There are two double bedrooms, both of which have an en-suite toilet, and 16 single rooms, many of which also have an en-suite toilet. The home is privately owned and managed by two business partners. They employ a matron to oversee the day-to-day care of the service users. The Statement of Purpose and the Service User Guide are issued to every prospective service user and both of these documents are readily available. A copy of the most recent inspection report is also available and a resident or relative/representative could request a copy from the manager. The fees for the home are £500-£600. The proprietor/manager made this information available on 17th September 2007 Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place over one day. The matron was present for the duration of the inspection and the registered proprietors/manager were present at the beginning and end of the inspection. All three were present for the feedback at the end of the inspection. The visit included talking to the cook, domestics and nursing and care staff about care practices within the home and they were also observed carrying out their duties. The inspector spoke to a number of residents who were asked to give their views on the service and their experience of living at the home. Relatives and a health care professional that were visiting the home at the time of the inspection were also asked their views and other relatives and social care professionals were contacted by telephone. A tour of the home was undertaken and all rooms were clean and free from any offensive odours. A random sample of residents’ files were case tracked, together with the examination of staff files and other records; medication charts, weight and fluid charts, staff rotas, training schedules, maintenance records and recruitment procedures. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment (AQAA) and Regulation 37 notifications. The inspector had a discussion with the manager and matron on the broad spectrum of equality and diversity issues and they were able to demonstrate a good understanding of the varied needs around religion, sexuality, culture, disability and gender. The inspector had a discussion with the manager, a relative and the people living in the home about how they wished to be referred to during the inspection and in the report. They expressed a wish to be referred to as residents and this is reflected accordingly in this report. The inspector would like to thank the residents and staff for their input during the inspection. What the service does well: The home has a welcoming atmosphere and is clean and tidy. Residents, relatives and staff all spoke about Avondale being a nice place to live and work. Residents were complimentary and stated, “I like living here, the staff are nice”, “ The staff help me with things I can’t do, and nothing is too Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 6 much trouble”. Relatives comments were also positive, “I am very happy with the care my dad receives”, and “She is happy, so I’m happy”. The registered proprietors have a daily presence at the home, one of the proprietors is the registered manager and they both work closely with the matron who has day-to-day responsibility for the welfare of the residents. Staff retention is good and many of the staff have worked at the home for a number of years. This is beneficial to the residents, as the staff are very knowledgeable of their needs. What has improved since the last inspection? What they could do better: The manager must look at residents’ individual aspirations and wishes regarding social activities, within the home and in the wider community. Though the home has undertaken some refurbishment and redecoration it is important that this programme is ongoing. There must be adequate staff on duty at all times, in particular between 7.459.00 on Saturday mornings, this is to ensure that residents’ health and safety are not compromised. All staff files must hold a photograph of the member of staff and all nursing and care staff must receive supervision at least six times a year. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 7 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. Avondale Nursing Home DS0000025947.V350696.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 Avondale Nursing Home DS0000025947.V350696.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): 1,3,4 and 5 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Prospective residents and their relatives have detailed information on the home, which assists them to make an informed choice about moving into Avondale. A pre-admission assessment is undertaken of all prospective residents; this will ensure that their identified needs can be met appropriately by the home. Prospective residents and their relatives are able to visit the home prior to their admission. EVIDENCE: The Statement of Purpose has been revised and further developed and this document is available to all residents and relatives. The Service User Guide is informative and written in plain English. It contains the terms and conditions Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 10 in respect of the accommodation, the service that will be provided and the complaints procedure. Residents have their own copy of the Service User Guide. There have been some new admissions since the last inspection. These files were examined and there was evidence that prior to admission, the manager or the matron had visited the prospective resident and an assessment had been completed. These assessments had been completed with information obtained from the resident (where possible), relatives, social and health care professionals. The assessment forms have been modified since the last inspection and now include information on people’s social care wishes and aspirations. Two residents told the inspector that they had been unable to visit the home prior to their admission but had relied on their families making the decision. One resident stated, “They made the right decision, I am happy here”. One relative stated, “I looked at other homes but chose this one because I liked the atmosphere and the way the staff spoke to the residents”. Another relative stated, “I could see my mum here, it felt homely”, another comment was “The home was recommended to me by a friend, whose father had been in here”. All of the relatives confirmed that they had spoken to the manager or matron regarding their relatives and felt confident that the home could meet their needs. The manager and matron confirmed that mostly it was relatives who visited the home, however they would be very happy for prospective residents to visit and stay for lunch or tea. The home is not registered to provide intermediate care. Avondale Nursing Home DS0000025947.V350696.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 and 11 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The health and personal care needs of each resident are set out in individual care plans. These plans provide staff with detailed information, which ensures that residents’ health and personal care needs are met on a daily basis. There are medication policies and procedures for staff to follow and medication records are being completed correctly. This safeguards the residents with regard to the administration of their medication. Residents are treated with respect and their arrangements for their personal care ensures that their right to privacy is upheld and particularly at the time of death they are treated with sensitivity and respect. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has their own care plan. The inspector examined four of these plans. There has been improvement in the care planning since the last inspection and care plans now identify areas such as personal care, mobility, continence, catheter care and social activities. There was evidence that care plans are being evaluated monthly and updated to reflect residents’ changing needs and six monthly reviews have also commenced. The inspector and the matron discussed the format of the review form and advice was given regarding the recording of residents/relatives/keyworkers views. Daily logs are being written three times a day and they relate to the care plans, however there is variance in the information that is recorded. Most of the staff wrote in a ‘person centred’ away e.g. ‘Y had a good night’s sleep; he only woke once, Y was offered a drink, which he declined and soon went back to sleep’. Other staff wrote notes that were brief and impersonal. The inspector discussed this with the matron and she is going to arrange for some of the staff to mentor their colleagues, to assist them in writing daily records in a way that is more informative. Records indicate that other health professionals including opticians, dentists, chiropodists, community and specialist nurses see the residents when required. The GP visits the home on a monthly basis and reviews every resident’s medication. The matron of the home regularly meets with the nurse practitioner and every three months with the diabetic nurse to review the residents with diabetes. Avondale have a number of residents with high dependency needs and at the time of the inspection none of these residents had a breakdown in their skin. This would indicate that the residents are receiving a good level of care. Other written evidence includes residents being weighed monthly with evidence of nutritional and fluid intake. A health care professional who visits the home stated, “The staff are very attentive and always follow my instructions”. Four risk assessments were examined and there was evidence that they are being reviewed monthly or when a change in need is identified. The assessments cover areas, such as, moving and handling, bathing, breakdown of pressure areas, use of cot sides, continence and falls. Residents, where possible, and relatives have been consulted in formulating these assessments. Medication policies and procedures were examined and found to be up to date. Qualified nurses administer medication and all have received training. Four residents’ Medication Administration Records (MAR) were examined and all had been completed appropriately and medication given correlated with the MAR charts. The matron undertakes regular medication audits. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 13 The inspector spoke to a number of residents and relatives who all stated that the staff were very respectful when attending to their personal care needs. One resident stated, “The girls are smashing, they really look after me”, another stated, “It’s a very nice place, the staff are kind”. Relatives stated, “I am very happy with the care, it’s better than the other home”, another stated, “I am very happy with the care, Dad is well cared for”. Staff were talked to and observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as the way they addressed residents, knocking on their bedroom doors before entering, talking to the residents and reassuring them when transferring them with the hoist. Residents’ privacy and dignity are covered during the staffs’ induction programme. One member of staff stated, “I treat the residents as I would want my mum treated, giving them the dignity and respect they deserve”. Though the home has not been directly involved with the ‘End of Life’ care initiative (information was given to the matron), there is evidence on some residents’ files that their wishes regarding dying and death are recorded as to whether they wish to remain at Avondale or go into hospital at the end of their life. Since the last inspection there have been five deaths in the home and four of the residents passed away at the home, this was the wish of the residents and their families. The manager and staff team are to be commended for respecting residents and families wishes and working closely with the health professionals for this to happen. It should be noted that this is a far higher percentage than the national average and the vast majority of people who live in residential care die in hospital. Thank you cards from relatives express their appreciation: ‘A little chapter of our lives made bearable by all the dedicated staff’, ‘I feel very lucky to have found Avondale and shall miss my visits’, ‘thank you for caring and making the end as best as it could be’. The home is to be commended for respecting residents and families wishes and working closely with the health professionals, for this to happen. A score of 4 has been given with regard to this standard. Avondale Nursing Home DS0000025947.V350696.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 and 15 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The residents are able to participate in an activities programme, however this could be more varied to suit individual preferences and capacities. Visiting times are flexible and visitors are made to feel welcome. This ensures that residents are able to maintain contact with families and friends. Residents are able to exercise choice and control over their lives. The meals are well presented and nutritionally balanced and offer both choice and variety to the residents. EVIDENCE: Residents were asked their views, and care plans and other records were examined. The visitors’ signing-in book showed that there is a steady stream of visitors to the home every day. The care plans contain information about residents’ social and spiritual activities and there is a record of all activities Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 15 that are undertaken. Weekly activities include: music and movement sessions, games, bingo, a musical entertainer, manicures, hairdresser, sing alongs and a cabaret singer at least every six weeks. Some of the residents receive weekly communion and there is a church service every two months. There has been some improvement in the range of activities however there could be further improvement in individual activities within the home and the community, such as, walks to the shops and park. This is Requirement 1 The home had employed an activities co-ordinator but unfortunately she has a serious illness and is unable to return to work. However the manager is confident that this post will be filled in the near future. Visiting times are flexible and visitors confirmed that they could visit at any time. All of the relatives that were spoken to said that they were always made to feel welcome and that they were offered tea or coffee. One relative stated, “I turn up at all different times and it’s not a problem”, “I bring my dog in with me and all of the residents love to stroke her”. Another relative stated, “I haven’t been visiting the home all that long but I feel very comfortable”. Relatives confirmed that they could see the resident in either one of the lounges or their bedrooms. Residents’ care plans indicate their preferred name and their wishes regarding their death. Residents are encouraged to bring their own personal possessions into the home and one resident bought his budgerigar. Meal times are flexible and on the day of the inspection, one of the residents was seen having her breakfast at 10 o’clock. Resident/relative meetings are now taking place and recommendations from these meetings have already been actioned, such as, staff are now wearing name badges. Meals are mostly served in the lounge, though some of the residents have their breakfast in their bedroom and one resident has all of his meals in his bedroom. The cook has worked at the home for a number of years and is very knowledgeable of all the residents’ likes and dislikes and their dietary needs. Some of the residents are diabetic and the cook advised the inspector that he tries to provide the same or similar dessert, so they do not feel different from the other residents. A few months ago, one of the residents asked if she could have soup before her lunch, other residents noticed and asked if they could have soup as well. Now all of the residents have soup at lunchtime and teatime. On the day of the inspection there were two choices for lunch; cottage pie or egg and bacon flan, all of the residents had chosen cottage pie and this was served with runner beans and cauliflower, dessert was chocolate cake and custard or fresh fruit. High tea was soup, Scrambled egg, cheese or egg on toast and fresh fruit. The cook confirmed that if a resident did not want either of the two choices, he would prepare them something different. For supper residents are offered a hot drink with either biscuits or a sandwich. One of the residents enjoys culturally prepared food, such as, swordfish, sweet potatoes, curried goat, rice and peas and yams. The refrigerators, freezers and store Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 16 cupboards were adequately stocked and refrigerator and freezer temperatures are taken and recorded daily. Some of the residents require assistance with eating their meals and staff were seen to carry out this task appropriately, facing and talking to residents and not rushing them. Avondale Nursing Home DS0000025947.V350696.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 and 18 People who use 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 and relatives can be confident that their concerns and complaints will be listened to and acted upon. There are policies and procedures on safeguarding adults and staff have undertaken training, which ensures there is an appropriate response to any allegations or concerns regarding abuse. EVIDENCE: The complaints book was examined and there had only been one complaint since the last inspection. The manager investigated the complaint and the complainant was satisfied with the outcome. The complaints procedure is on the notice board in the hallway. Three residents were asked, “If you were unhappy about anything in the home, who would you talk to?” Two residents stated, “I would talk to X (the matron)”, the other resident stated, “I would tell Y (member of staff)”. All of the residents have family who are in regular contact and they would be able to advocate on their behalf. Relatives that were spoken to said that they would talk to either Ruth or Inde Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 18 (proprietors) or the matron and felt confident that their concerns or complaints would be acted upon. One relative stated, “I went to Ruth with something minor and she dealt with it straight away, they are very good like that”. Neither the local authority nor the Commission have received any complaints regarding Avondale. Families or representatives administer all of the residents’ finances. The home holds small amounts of money for hairdressing, chiropody and toiletries. Four residents’ monies were checked and all were accurate with receipts tallying with the amount of money spent. There is a written policy for dealing with ‘safeguarding adults’ issues and whistle blowing. The home also has a copy of the local authority (London Borough of Redbridge) documentation on ‘safeguarding adults’. This subject is dealt with as part of all staff induction programme and further formal training has been undertaken. All of the staff have attended ‘safeguarding adults’ training. Staff that were spoken to were very informed on the different types of abuse and what action they needed to take if there were any concerns regarding the welfare and safety of the residents. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 19 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): 19,20,21,23,24,25 and 26 People who use 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. Residents live in a clean and hygienic environment, with access to indoor and outdoor facilities. However a few of the bedrooms need to be redecorated and carpets replaced and there are some inappropriate chairs, which could put residents’ safety at risk. There are sufficient toilets and bathrooms situated on both floors. EVIDENCE: A tour of the home was undertaken and all areas were inspected including the kitchen and laundry room. Both of these rooms were maintained to an acceptable standard. There was a good supply of food within the refrigerators Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 20 and freezers and this was stored appropriately. There was evidence that refrigerator and freezer temperatures are being recorded on a daily basis. The living area of the home consists of two lounge/dining rooms; one of the lounges is smaller than the other. Both of these rooms have recently been fitted with new carpets and were clean, tidy and free from any offensive odours. On the day of the inspection the larger lounge looked particularly festive as one of the residents was celebrating her 92nd birthday and her family had filled the room with helium balloons. There are no dining room tables and residents eat their meals from small individual tables in front of their armchairs. Though there are sufficient armchairs; two of the armchairs in the smaller lounge are inappropriate, as they are shabby and far too low (all of the residents would need assistance in getting in and out of them). These need to be removed and replaced with appropriate armchairs. This is Requirement 2 All of the residents’ bedrooms were clean, tidy and free from any offensive odours. All of the bedrooms were personalised with televisions, radios, photographs, pictures, cuddly toys, ornaments and pictures representing the resident’s faith. One resident has his budgerigar in his bedroom and another resident keeps her ornaments in a lovely corner unit. Most of the bedroom furniture and soft furnishings (curtains, carpets and bedspreads) were in good repair. However some attention is required to three of the bedrooms; two need new carpets, one needs redecorating and in another bedroom the chair needs to be cleaned. The upstairs hallway has lots of marks on the walls and a coat of emulsion could remedy this. It is important that the home is safe and well maintained. This is Requirement 3 There are sufficient toilets and bathrooms on both floors and all were seen to be clean and all equipment in good working order. One of these bathrooms has recently had a walk-in shower installed; this offers residents a greater choice of bathing facilities. There is a large garden at the back of the home and the matron advised the inspector that during the summer months some of the residents enjoyed sitting in the shade. The home is cleaned on a daily basis and throughput the inspection all area of the home were found to be clean and tidy. There are adequate control systems in place to ensure that the home is free from any offensive odours. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 21 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 and 30 People who use 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’s staffing levels are generally satisfactory for the current number of residents, and most of the time there are sufficient staff on duty, who have the appropriate training and skills to meet the needs of the residents. The home has a clear recruitment policy and procedure and appropriate checks are undertaken, which ensures the protection of the residents. EVIDENCE: Staff rotas were examined and the rota correlated with the number of staff on duty. During the day there are 3 care staff (currently there are only 16 residents) and 1 nurse and 1 care staff and 1 nurse during the night. The home has good staff retention; only one member of staff has left the service in the past twelve months. The home had employed an activities co-ordinator but due to a serious illness, she is unable to return to work. The post is currently being recruited to. The cook has completed his NVQ 2 in catering and works a six-day week 7.45-14.15 Sunday-Friday, the cook who works on a Saturday works 9.00-14.00, the inspector asked who prepared breakfast on this day and was advised one of the care staff. This is unacceptable as this leaves only 2 care staff and 1 nurse to assist the residents at one of the busiest times of the Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 22 day in a care home. The registered persons must ensure that there is cover in the kitchen from 7.45-9.00 on Saturdays, to ensure that residents’ safety and welfare are not compromised. This is Requirement 4 Four staff files were examined and they showed that all of the relevant recruitment procedures had been adhered to; all files had a completed application form, two written references, satisfactory Criminal Records Bureau checks and copies of passports and National Insurance details. There was evidence that not all of the staff files held a photograph, as required by the Care Homes Regulations 2001. This is Requirement 5 All newly appointed staff undertake an induction programme, however it is recommended that the manager revisits the programme to ensure that it is in line with the Skills for Care Council induction programme. This is Recommendation 1 Other training that has been undertaken in the past twelve months includes; safeguarding adults, food & hygiene and infection control. The manager and 4 staff are undertaking a distance-learning course in ‘The safer handling of medication’. This course is certified by the National Certificate of Further Education. Other courses that have been booked are: Mental Capacity Act and Dementia Awareness (level 2). Currently 6 staff are completing their NVQ 3 and seven are completing their NVQ 2; this means by the end of November all staff will be either NVQ 2 or NVQ 3 trained. Staff that were spoken to stated, “I love working here”, other comments were, “I have worked in another care home and this is far better”, “I have worked from being a domestic to a carer completing my NVQ 3, I enjoy doing the training and it has made me a better carer”. Avondale Nursing Home DS0000025947.V350696.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): 31,33,35,36,37 and 38 People who use 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 live in a home that is run in their best interests by an experienced and qualified manager. Residents’ financial interests are safeguarded by the policies and procedures of the home. Staff have received yearly appraisals, however there needs to be a system in place to ensure that staff receive regular supervision. Residents and staffs’ health and welfare are promoted and protected. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered proprietors/manager are registered nurses and have many years and substantial experience in managing a care home. They both spend a considerable amount of time at the home and are supported by a very experienced matron. All three of them have a very real understanding of the needs of the residents and the areas in which the home needs to improve and further develop. Comments from residents, relatives, staff and health and social care professionals were very complimentary of the management, with comments; ‘they are very helpful’, ‘X (matron) is very supportive’, ‘they are very approachable’, ‘they have the residents’ best interests at heart’, ’we have no concerns’. The proprietors are currently developing a development plan, which will reflect the aims and outcomes from residents. This plan will come as a result of residents/relatives/staff surveys, residents/relatives meetings and meetings for all of the staff. Some suggestions have already been actioned: relatives felt it would be useful for staff to wear name badges, these have been provided. Staff commented on the quality of the rubber gloves, these are now being ordered from a new supplier. The findings of the surveys were very positive; ‘overall impression of the home is very good’, ‘would recommend the home’. There is an appropriate policy and procedures regarding the safeguarding of residents’ finances. The home only holds small amounts of money for hairdressing, chiropody, toiletries and other small sundries. Residents’ accounts that were checked showed sound financial procedures are being followed and all receipts tallied with money spent. Towards the end of the inspection the manager was observed leading from the front, by directly engaging with residents, relatives and staff. Residents and relatives were complimentary and all of the staff that were spoken to spoke very highly of the management team and how well they felt supported by them. There was evidence that staff are receiving supervision, however this needs to be on a more regular basis (at least six times a year). This is Requirement 6 Annual appraisals, regular staff meetings and direct observations of staff care practices are taking place. This was confirmed by staff and records of these meetings were seen. The manager was able to demonstrate her knowledge and commitment to equality and diversity issues, which are given priority in caring for the service users. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 25 As previously stated, in the main record keeping is of a good standard, with records being kept securely in accordance with the Data Protection Act. All of the working practices are safe, within a risk management framework. The manager proactively monitors the home’s Health & Safety performance and consults other experts and specialist agencies when necessary. Risk assessments were in place for fire, first aid, infection control and moving and handling. Fridge and freezer temperatures are taken and recorded daily and food that was stored in the fridge and freezer was covered and dated. Fire drills are taking place regularly and it is recorded as to where the ‘fire’ had started and how long it took to evacuate the building. Fire extinguishers received their annual check in May 2007; the fire officer visited March 2007. The annual Gas safety certificate is dated October 2007; the five-year Electrical safety certificate is dated June 2006 and the Portable Appliance Testing was carried out April 2007. The lift was serviced March 2007 and hoists were serviced in November 2006. At the time of the inspection there were no issues relating to Health & Safety, which means the service users’ safety is assured. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 26 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 Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 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 3 2 3 X 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 3 3 Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP12 Regulation 16(2)(n) Requirement The registered persons must ensure that residents are offered a range of activities in the home and the community that meet their wishes and aspirations. The registered persons must ensure that the furniture within the home is fit for the purpose and is appropriate to the needs of the residents. The registered persons must ensure that all of the residents’ bedroom furniture, floor covering and décor are fit for the purpose. The registered persons must ensure that there are sufficient numbers of staff on duty at all times, to meet the needs of the residents. The registered persons must ensure that every staff file has a photograph of the member of staff. Timescale for action 31/01/08 2. OP20 23(2)(a) 31/01/08 3. OP24 23 (2)(b) 31/01/08 4. OP27 18(1)(a) 31/10/07 5. OP29 Schedule 2 (1) 31/10/07 Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 28 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. Refer to Standard OP27 Good Practice Recommendations It would be good practice for the manager revisit the home’s induction programme to ensure that it is in line with the Skills for Care Council induction programme. Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 Avondale Nursing Home DS0000025947.V350696.R01.S.doc Version 5.2 Page 30 - 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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