Inspection on 14/06/07 for Avondale Nursing Home

This inspection was carried out on 14th June 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 22/06/06

Avondale Nursing Home 04/01/06

Avondale Nursing Home 19/10/05

Avondale Nursing Home 21/03/05

Avondale Nursing Home 09/09/04

Avondale Nursing Home 17/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Avondale Nursing Home 21 Eldorado Road Cheltenham Glos GL50 2PU Lead Inspector Mr Adam Parker Key Unannounced Inspection 09:30 14 & 18th June 2007 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 DS0000055437.V340156.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 DS0000055437.V340156.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avondale Nursing Home Address 21 Eldorado Road Cheltenham Glos GL50 2PU 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) 01242 232012 F/P 01242 232012 European Healthcare Group plc To be Appointed Care Home 20 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (20) of places Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2006 Brief Description of the Service: Avondale is an extended house in a residential area outside of Cheltenham Town Centre. It is close to the main bus routes and railway station. Accommodation is across four levels and consists of single bedrooms with wash hand basins and ample communal space. A shaft lift allows access for wheelchair users to the upper floors; there is also a stair lift. An outside ramp gives access to the lower ground floor level as two steps separate this internally. At the front of the house is parking for several cars and a lift platform for wheelchair access to the front door. There is an enclosed garden at the rear of the home. The home provides nursing care for elderly persons of which 5 beds are designated to the care of those with dementia. Current fees are £470.00 to £680.00. Hairdressing, chiropody, newspapers, resident’s own preferred toiletries and some outings are charged extra. The home makes information about the service, including CSCI reports available to service users and their representatives through a service user guide and statement of purpose available in the home. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was carried out by one inspector over two days in June 2007. One resident was spoken to during the inspection visit to gain their views on the service provided. The manager of the home was present for the both days of the inspection visit which consisted of a tour of the premises and examination of residents’ care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. Comment cards were received from residents, their relatives, staff working in the home and from General Practitioners (GP). The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? The home has improved the information available to residents and their representatives both in terms of the service provided and information about how to make a complaint. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 6 Residents are now being protected by an improved approach to risk assessment and robust recruitment procedures with some improvements made in the safe storage of cleaning materials. In addition the skills and knowledge of staff working in the home have been improved through training and systems are in place to ensure that agency staff have sufficient information to meet resident’s needs. Though incomplete, work has started on improving the physical environment of the home. What they could do better: 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 DS0000055437.V340156.R01.S.doc Version 5.2 Page 7 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 DS0000055437.V340156.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission procedure ensures that all service users are admitted to the home on the basis of a full assessment of their needs, so that they can receive the care that they require. EVIDENCE: The assessment documentation for two residents recently admitted to the home was looked at. These had been completed following an assessment of the service user’s needs by the registered manager and were based on ‘activities of daily living’. With one resident who had been in the home for some time it was noted that the assessment had been reviewed when there was a change in circumstances. In addition copies of discharge summaries from hospitals had been obtained as well as assessments and care plans carried out by the funding authority. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 9 The manager stated that in the case of potential residents receiving funding from a local authority, the home would not consider the resident for admission until it had received a copy of the assessment and care plan. The home does not provide intermediate care and so Standard 6 does not apply. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. The home works well to meet residents’ health and personal care needs whilst upholding their privacy and dignity. EVIDENCE: Care Plans were detailed and individualised giving clear instructions for staff to follow to meet residents’ needs. In some cases the numbers of staff needed for certain care tasks was indicated. Relatives of residents are invited to view care plans and one example was seen of a care plan being signed by relatives after they had read it. Risk assessments had been completed for pressure areas, moving and handling, use of bed rails and nutrition with a record of residents’ weights being kept. Both care plans and risk assessments had been reviewed on a monthly basis and it was clear that where a need was identified through assessment, a care plan was written to manage this. One resident with a learning disability had been referred for review by the learning disability team following staff concerns. Comments from a relative Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 11 regarding the care given to a resident were “Her health has improved since being at Avondale and this is down to the high level of individual care provided.” The arrangements for medication storage, administration and recording were checked. Medication was stored securely in one location in the home with a trolley in another area. However there were no records of storage temperatures and these must be monitored to check if medication is being stored at the correct temperature. Regular checks were being recorded on the refrigerator used to store some medication and showed that temperatures were within the correct range. It was noted that all bottles of liquid medication, and eye drops had been dated on opening. Handwritten entries in medication administration sheets had been signed and dated by the staff member with a second signature by the staff member making the entry. This practice should be extended to all handwritten comments or marks on the administration sheets such as where medication has been stopped. An audit of medication records and practices has been carried out in the past and it was reported that another was due to be done. Staff were observed treating service users with respect and shared rooms had curtains in place to maintain privacy. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. The home has a varied programme of activities suitable for all residents and encourages contact with family, friends and parts of the local community providing a good degree of social contact. In addition resident’s are well supported by staff at mealtimes although required records of meals provided have not been maintained. EVIDENCE: The home provides activities for residents both individually and in groups. These include music afternoons, clothing parties, art lessons, Indian head massage, hair and nail therapy and chair activities. A record is kept of activities provided and which of the residents took part. Residents’ visitors are invited to relatives’ meetings and take part in some of the activities such as music sessions. Visitors can also join residents for tea and during the inspection visit one visitor was assisting a resident with lunch. Residents have attended concerts at a local school and students from the school have visited to join in activities such as gardening and dominoes. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 13 Holy Communion is provide in the home every Wednesday by the Church of England. The home has information about local advocacy services for residents and had cause to contact one of these recently although the service was described as being of “no help” to the resident and alternative legal arrangements were followed. Residents can bring in their own furniture and electrical equipment to the home if this fits into their rooms and if it passes safety checks. Evidence of this was seen during a tour of the premises. The serving of lunch was observed, some residents took their meals in their own rooms. Those that needed some help with eating took lunch in one of the lounges where staff could provide assistance. The menu provides a choice of main dish for lunch and there is a variety of sandwiches or a cooked snack for tea. Where meals were pureed they were presented in an attractive way with all the portions of the meal identifiable. At the previous inspection a requirement was made regarding records of food provided for the residents and of any special diets prepared. Examination of the records kept showed that these were incomplete, inaccurate in places and did not give very much information about special diets or alternative meals provided for residents. The cook is currently undertaking an NVQ in professional cookery. One resident spoken to during the inspection visit stated that the food was “excellent”. A relative of a resident stated that the relative had “numerous cups of tea” on a survey form. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 14 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. Complaints are acted upon in the interests of residents and the homes’ approach to training staff should ensure that residents are protected from abuse. EVIDENCE: The complaints procedure is normally displayed in the entrance of the home although during the inspection visit this had been temporarily removed due to building work. A survey form received from one relative of a resident confirmed the normal positioning and availability of the complaints procedure. The home keeps a log for recording complaints, three recent complaints were looked at and the investigation of these had been fully documented. With one complaint the response had included regular meetings with the family of the resident. The home also has a log for recording informal complaints. Training for staff in measures to protect residents from abuse starts as part of the induction training which includes the ‘whistle blowing’ policy and the ‘no secrets’ guidance. This initial training is followed by annual updates. The manager has attended the Gloucestershire local authority enhanced training in safeguarding adults and in a previous role in another part of the country attended a 13 week course on the protection of vulnerable adults. She has collected an extensive file of documents on the subject. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 15 The home has individual plans in place to deal with a small number of residents who may exhibit challenging behaviour although no specific training has been given to staff this is planned for the future. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 16 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): 19,24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Current building work in the home does not provide an ideal environment for residents however the benefits of comfortable, clean and personalised. Individual rooms have been maintained. EVIDENCE: During the inspection visit a great deal of building and refurbishment work was being carried out which would be going on for several months. This situation was not ideal for the residents or staff although it is appreciated that this work has to be done to improve the environment of the home. Plans for the home include refurbishing residents rooms when they become empty and replacing the existing bathrooms with ‘wet rooms’. On the top floor of the house an area previously used as a staff flat was to be converted into an office and it was hoped that a staff training facility could be Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 17 provided here. Where individual rooms were still in use these showed degrees of personalisation The laundry was checked on the first day of the inspection visit. This was not in a good state of order with unwashed laundry tipped out on the floor and although disposable gloves were available there was lack of soap and paper towels. In addition the sink for hand washing was not readily accessible. accessible. On the second day of the inspection visit the laundry was checked again and the situation had greatly improved. It is planned to replace the current laundry with a new facility as part of the work being carried out on the home. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 18 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. Although appropriate staffing levels, induction and robust recruitment practices are in place in the residents should benefit from an improvement in the numbers of staff trained to NVQ level 2 or above. EVIDENCE: Staffing in the home consists of one registered nurse for the day shift with four care assistants in the morning and five in the afternoon. A fifth care assistant works on the morning shift when hair dressing is being carried out. At night there is one registered nurse and one care assistant. Ancillary staff consist of a cleaner, a cook and a kitchen assistant. The home has had some problems with attracting and retaining staff and has had to make use of agency staff. In order to preserve some continuity in care these are generally staff who are familiar with the home. The home has one care assistant with an NVQ level two and a further two carers undertaking NVQ level two and one doing NVQ level three. Some of the care assistants in the home have overseas nursing qualifications. However the home must continue to improve the numbers of care staff trained to NVQ level two or above. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 19 Records for recently recruited members of staff were examined. All the required information and documentation had been obtained including an employment history. Checks against the Protection of Vulnerable Adults list were being made as well as with the Criminal Records Bureau. At the time of the inspection visit the home was about to introduce a new induction training package using the common induction standards. However it was confirmed that all staff had received induction training using a programme devised by the manager. Dementia training and first aid training have been provided for staff. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is managed in their interests with actions carried out to ensure their safety and the quality of the service. EVIDENCE: At the time of the inspection visit the manager was still undergoing consideration for registration with the Commission. She is a registered general and mental nurse with over 25 years experience of nursing and management in South Africa and the United Kingdom. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 21 The home carries out a number of audits to ensure that the home is run in the best interests of the residents. These include audits of accidents and incidents, record keeping and medication. Surveys had been sent out to residents’ relatives to gain their views on the home although it was reported that only a small number returned the survey form. The home has been involved in the End of Life Care Initiative which is a project aimed at improving the care of dying people in care homes by increasing the knowledge, skills and confidence of staff in the home. The home provides secure facilities for residents money and looks after money for a number of residents although others have their financial arrangements taken care of by family members. Appropriate records were kept for any residents’ money held and each resident had a clear plastic wallet which was a useful way of checking the amount held. The home does not pay any money into bank accounts on behalf of residents. Staff have received training in first aid, moving and handling, health and safety fire safety and food hygiene. The manager has undertaken training in infection control although as detailed elsewhere in this report other staff should also receive suitable training in this area. Accidents and incidents are appropriately recorded and as mentioned above subject to a monthly audit which along with a number of other issues looks at the time of the accident and where it took place. Monthly checks are carried out and recorded on temperatures from hot water outlets and on window restrictors. Servicing has been carried out on lifts, the central heating system and electrical wiring with an annual check being made on portable electrical appliances. The home has used a specialist consultant to undertake a risk assessment in relation to Legionella, this is comprehensive and takes into account older people in the home. In relation to this risk assessment work has been carried out and a number of control measures are in place to minimise the risk. The safe storage of cleaning materials has been improved since the last inspection and staff have undergone training in handling hazardous substances. It was noted however that one bottle of disinfectant in use was not adequately labelled although this was not the general practice in the home. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 23 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 OP15 Regulation 17 Schedule 4(13) Requirement Timescale for action 31/08/07 2. OP28 18 (1) (c) (i) The Registered Person must ensure that records are kept of any food provided for the residents and of any special diets prepared. This requirement has been repeated from the last inspection. Arrangements must be made to 31/01/08 ensure that more staff are enrolled in NVQ training so that residents are cared for by trained staff. This Requirement has been repeated from the previous inspection. 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 OP9 Good Practice Recommendations The practice of signing, dating and checking handwritten directions on the medication administration charts should also be used when any medication is stopped and the chart is marked accordingly. DS0000055437.V340156.R01.S.doc Version 5.2 Page 24 Avondale Nursing Home 2. 3. 4. 5. OP9 OP26 OP38 OP38 The temperature in the medication storage room should be monitored and recorded to check that residents’ medication is being kept at the correct temperature. Checks should be made on the laundry to ensure that infection control procedures are being followed. More staff should receive training in infection control procedures especially those who with responsibility for working in the laundry. Checks should be made to ensure that cleaning substances are not decanted into unmarked or inadequately marked bottles. Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Avondale Nursing Home DS0000055437.V340156.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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