Inspection on 19/10/05 for Avondale Nursing Home

This inspection was carried out on 19th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Avondale Nursing Home 01/06/09

Avondale Nursing Home 06/09/07

Avondale Nursing Home 27/06/06

Avondale Nursing Home 06/02/06

Avondale Nursing Home 22/12/04

Avondale Nursing Home 02/09/04

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

CARE HOME ADULTS 18-65 Avondale Nursing Home Delphside Ltd 11 Sandstone Drive, Off Delph Lane Whiston Prescot Merseyside L35 7LS Lead Inspector Natalie Charnley Unannounced Inspection 19th October 2005 09:30 Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 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 DS0000005451.V262438.R01.S.doc Version 5.0 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 Adults 18-65. 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 DS0000005451.V262438.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Avondale Nursing Home Address 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) Delphside Ltd 11 Sandstone Drive, Off Delph Lane Whiston Prescot Merseyside L35 7LS 0151 431 0330 0151 430 0186 Delphside Limited Mr Peter Hamlett Care Home 50 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (50) of places Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to Include up to 50 (MD) Date of last inspection 22nd December 2004 Brief Description of the Service: Avondale Nursing Home is a purpose built unit providing 24 hour nursing care for residents with mental health problems. The home is run by a charity, Delphside, which was formed in 1991. The home accommodates up to 50 residents at one time. The organisation recognises that on admission to the home residents may be very ill, however symptoms may subside over a period of time. As a consequence the home has introduced a rehabilitation programme for those people who show signs of improvement so that they may eventually be able to leave the home and move to a supported living project. The home is located in the Prescot area of Liverpool, close to Whiston Hospital and is easily accessible by road and public transport. It is on ground floor level and split into four separate units. There is also a substantial garden area surrounding the home. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day. Two inspectors visited the home. The inspectors arrived at the home at 09.30 and left at 18.30.The inspectors spoke to the manager and his deputy, two administrators, six care/nursing staff and 12 residents. The inspectors completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports. The inspectors followed an inspection plan written before the start of the inspection to ensure that all areas that needed covering were done so. Feedback was given to the manager and his deputy during and at the end of the inspection and due to serious concerns regarding the administration of medication and safety of the residents; two immediate requirement notices were issued. This is explained in detail in the main body of the report. What the service does well: What has improved since the last inspection? The home have introduced a new mental health assessment and risk assessment document to improve planning of care for residents. Staff are in the process of putting these into practice. The home have employed a nurse as a ‘Clinical Development Facilitator’ to assist with developing and delivering training to staff. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 6 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. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Potential residents can make an informed choice before moving into the home. Some residents at the home may not be appropriate to the placement and may not be having all of their needs met, leaving them at potential risk. EVIDENCE: Residents who are thinking of moving into the home are visited by the manager who completes an assessment. The resident is given a copy of the homes statement of purpose and service user guide which details what the home offers. This allows them to make an informed choice. Residents move into the home on an initial three month trial period to allow staff and the resident themselves time to see if the home is suitable. Staff were concerned that some residents were not within the homes category and recent admissions to the home required “more 1-1 care that the staff could not provide. Staff commented that there is an older population within the home that in their opinion, their physical needs outweigh their mental health needs and as a result of this staff feel the time given to residents needing more physical care has increased which affects the time given to residents who need less personal care is reduced. Staff were concerned that they were not consulted regarding potential resident admissions and felt they should be included in deciding whether or not the home could meet the needs of the resident before admission took place. They described the new assessment document now used by the home as very detailed, staff are currently being trained how to use it. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 9 Details are recorded about a residents previous mental health problems, their thoughts about their illness, details of their behaviour, mood, speech and physical health problems. This is then used along side the ‘clinical risk assessment tool’ which looks at risks that are presented to the resident, other people and the environment. Both of these documents are then used by staff to make a detailed plan of care for residents. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 and 9 Care plans and risk assessments are individual and reflect the needs of residents living at the home Residents can make individual choices and participate in the running of the home EVIDENCE: Six care plans were looked at by the inspectors and a further four were case tracked to look at specific residents that had been identified. Care plans have been re-designed since the last inspection and are now clear to follow. Many of the plans are now in this new format, however some still need to be updated. Residents sign their care plans where possible and those who are unable to do so or refuse have this clearly recorded. The home are currently looking at developing a ‘continence plan’ to add to these records. Plans show that residents are receiving care from a variety of health professionals such as doctors, psychiatrists, social workers and opticians. Visits by these people are recorded in care plans. Plans are reviewed on a regular basis to ensure they are kept up to date. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 11 One resident who had recently moved to the home from another local home, had a care plan and other documents from the old home and not from Avondale. The inspector was not clear as to why the new documentation was not used in this case. Risks undertaken by residents are clearly documented and updated by staff. A new policy has been put in place since the last inspection in relation to if a resident goes missing. Residents at the home can come and go as they please and so risks are assessed regarding their ability to do this safely. Residents living at the home are invited to attend the residents forum, notes of these meetings was examined at by the inspector. Residents use this forum to give ideas and suggestions as to the running of the home, activities and trips out and staffing issues. Notes are recorded in a style that residents can easily read and have colourful pictures to help residents understand what has been discussed. Residents had recently asked to go out to the cinema which had been organised by the home. Residents are currently deciding if they would like staff to have a uniform or not. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,13,14,15,16 and 17 Links with the local community are good and support resident’s social opportunities Activities are varied and suit the needs of individuals Meals at the home are good offering choice and variety for residents. Resident’s dignity is not always maintained by staff, therefore not meeting their needs EVIDENCE: No residents at the home currently participate in education or employment. One service user who has left to live in the local community still attends the home for a little support when needed. The home have their own mini bus and residents have been on holidays to Blackpool, Yorkshire and the Lakes this year. The home are planning a holiday to Southern Ireland in the near future and are currently arranging for residents to get their own passports. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 13 The home have a structured activity plan which is displayed throughout the home and discussed as part of the residents forum. Activities take place both inside and outside the home and are supported by staff. Residents spoken to by the inspector particularly enjoyed the art group. The most recent residents forum meeting shows that residents have participated in local walks, picnic and poetry day, life skills (which enables residents to learn and develop skills they will need to live in the community) and reminiscence. Residents and staff confirmed that the home allows visitors at any time of the day. Two residents at the home plan to marry in 2006 and are supported in this by the home and their families. Staff at the home were observed being polite and courteous to residents and addressing them in an appropriate way. Staff were observed knocking on doors before entering and handing out individual mail. One resident was observed sitting on the toilet without the door closed with staff passing the door on numerous occasions. This occurred in the afternoon as the inspector was making their way to the office to give feedback. This issue was raised in feedback with the manager. This resident was also observed to have dirty clothes and be in an unkempt state. Staff must ensure that all residents dignity is maintained at all times and any problems are recorded in the care plans. Residents living at the home are assisted by staff to develop skills needed for independent living. Specific areas of the home are used for this and staff assist residents at all levels of ability. The home has designated smoking lounges and residents are not allowed to smoke in their bedrooms. Risk assessments regarding smoking are kept on care plans. Discussion with staff and 5 residents concerning meals and snacks revealed that good food is provided. Residents enjoy the food and described it as “great” “like it”. Staff described the meals as “well provided for” “The food is Good residents can have anything they want” The stocks of food and variety of menu observed was good. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Residents receive personal care in the way they prefer maximising choice and independence Specialist health care support is offered to residents and ensures that health needs are met The home has failed to improve their procedures for administration and recording of medication, leaving residents at risk of harm. EVIDENCE: Residents were observed to be accessing various areas of the home independently of staff. Residents were also observed using their rooms and areas outside of the home independently. One resident confirmed rising and retiring times are flexible and “up to me to decide” Residents at the home are all registered with a local doctor. The vast majority of which have one designated GP (General Practitioner) who visits on a weekly basis or when needed. The inspector met with this GP during the inspection who described the home as “very good indeed” and went on to speak highly of the staff and how organised they were. He stated “this home is one of the best that I have ever visited and I have been a GP for many years”. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 15 The home use local hospitals and specialist mental health services to care for residents, details of communication between a variety of health related fields is contained within the care plan. Residents are also offered a yearly health check, although some refuse this. The inspectors examined the drug clinic and all records relating to medication management during the inspection as the home had received requirements in previous inspections, including a specialist pharmacy inspection. Several areas of concern were again highlighted. There were several gaps in the recording of medication at the home including when recording controlled drugs. There were many items that were overstocked at the home and dated back to earlier in the year. One medication found in the drug trolley was unlabeled which meant the inspector could not identify who it was prescribed for. Many drugs were not being given as they had been prescribed and many entries made in medication records were scribbled out or changed. There were no records of old pharmacy returns available as staff could not locate the records. The inspector found several discrepancies in the stock balances of controlled drugs and staff stated that the use of two controlled drug records was causing mix ups in recording. Oramorph, a liquid morphine bases medication was not being accurately measured and advise was given regarding using a syringe or graduated bottle to ensure doses are accurate. Staff informed the inspector that they had not seen a copy of the full pharmacy report that was done in 2004 and also stated that they had raised concerns about the pharmacy used by the home to the manager but nothing was done about it. Staff had also never seen any drug alerts that had been sent to the home and stated that recent training that was provided on medication management was inadequate. The inspectors watched the teatime medication being given out, which was over a long period of time where residents came out of their bedrooms to line up at the treatment room. Following the previous inspections, a small medication round takes place in the residents lounge which is a better practice, however, neither route promotes dignity or confidentiality. Residents in the lounge were having to store water cups to take medications in ashtrays and those waiting at the medication room showed institutionalised behaviour. Due to the serious concerns raised regarding medication administration, the inspector issued an ‘immediate requirement notice’ which requires the home to sort these problems out as a matter of urgency. Since the inspection, a follow up visit has taken place which has again identified areas of concern. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has a clear complaints procedure that residents and relatives can access. Arrangements for protecting residents are not satisfactory and leave residents at possible risk from harm or abuse. EVIDENCE: The home have a complaints procedure that is accessible around the home for service users. Residents have their views listened to by staff on a daily basis and through their forum meetings. There has been one complaint made to the home since the last inspection which has been addressed. Staff working at the home are police checked and checked against the POVA(Protection of Vulnerable adults) register. The inspector sampled five staff files, including that of the most recent members of staff. One was found to contain no police or POVA check. There was also only one reference on file. All other files contained the correct information needed by the home. Staff at the home knew that the adult protection policies were kept in the office, however some had not seen them. Some members of staff stated that they were not aware of what to do if an allegation of abuse is made at the home, this needs to be addressed by the manager and suitable training needs to be given. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,28 and 29 The overall quality of some bedroom and corridor areas at the home is poor and is not creating a pleasant environment in which to live. The home is leaving residents at risk from harm by not having functioning fire door alarms and no master room keys for staff. Residents do not always have access to the necessary equipment they need to maintain independence and safety. EVIDENCE: Observation of resident personal space and communal space was carried out. Resident’s rooms appear to reflect their individuality, from not personalised to very personalised, untidy to tidy. The corridors are long, and these lead to a central point that is no longer used as a nurses station. This central area could be made more attractive and comfortable by the use of pictures and chairs. The general hygiene and cleanliness throughout the home was good. Although smoking is restricted to designate areas, some of the bedrooms visited need replacement carpet. Previous or present occupiers are not managing to restrict their smoking to areas permitted as carpets have cigarette burns. This raises an issue of safety. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 18 Many of the residents smoke in the designated area, however, there was evidence of smoking about the building, discarded cigarettes ends were found in bedrooms, and corridors. Some residents at the home have Yale locks to their bedroom doors, which is good practice and allows residents to have independence. Staff raised concerns that they did not have immediate access to master keys to open these doors in the event of an emergency. An immediate requirement notice was given to the home to ensure the safety of residents and ensure staff can gain entry to bedrooms if needed. Wheelchairs were available for those residents with mobility issues. However, they were not wheelchairs specific to the individuals. Residents needing wheelchairs should be assessed and measured by a specialist and a personalised chair obtained. One resident with a physical disability was observed using a standard manual wheelchair, without footplates. He was using his feet to propel the chair along the corridors, although he appeared very skilled using it, it is not designed for him. To assist him and give him safer and better control over his mobility he should be assessed for both manual and electric wheelchairs. On the day of the inspection, fire doors, which are all alarmed to let staff know if they are opened, were not working. The home stated that this was in the process of being repaired. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 and 36 Staff need additional training to ensure they can meet the needs of residents The home have a sufficient staff compliment to meet the needs of residents. Supervision needs to be developed to support individual staff EVIDENCE: Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 20 The home employs a large number of duel qualified nurses and appropriate support staff. Some staff are also duel qualified general nurses. Proof of these qualifications was seen during the inspection. There is always a qualified nurse on duty 24 hours a day. Rotas at the home showed that there are enough staff to care for residents living at the home and that the turnover of staff is low. Residents are allocated ‘key workers’. This means each individual is given a specific member of staff to work with to plan and deliver their care. Residents were aware of who these workers were. Staff confirmed that they receive a variety of training and training records are now up to date at the home. Staff stated they had completed training on food hygiene, clinical development and infection control during the past twelve months, however in discussion with some staff they had not been updated in manual handling or abuse awareness. This needs to be addressed by the home. Staff files and interviews confirmed that they receive a comprehensive induction when starting work at the home. Discussion took place with the home manager with regard to staff supervision. The home are hoping to introduce a formal clinical supervision system for staff in the new year, however no formal clinical supervision takes place at present to discuss ideas, concerns or training needs for staff. Management supervision is taking place on a daily basis, and an annual appraisal is given to staff. Staff meetings are held on a regular basis where staff can discuss issues with management. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38,39 and 42 Communication between some staff and care managers is poor leading to a breakdown in their view in the way information is passed down, this could leave residents at risk. Some staff expressed a lack confidence in the management of the home. The home monitor quality effectively and seek the views of residents. The home have planned for future developments to develop the service for residents EVIDENCE: The home have recently been re accredited for Investors in People, which is an external quality assurance scheme. The home has an annual development plan and feedback is sought by way of the residents forum. The home are currently obtaining views of staff and residents regarding the need for more domestic staff and the use of staff uniforms. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 22 Staff and residents at the home have undergone fire training on a six monthly basis. Certificates are in place in relation to the health and safety issues in the building. The home also have appropriate insurance cover. Health and safety issues are discussed at a forum of staff members on a regular basis. The home have implemented the new system for disposal of medication. The home has an operational CCTV system, however at present this does record images. Discussion with 6 staff on their views on how the home is managed using the questionnaires was not positive. Confidentiality, Consultation and Communication being significantly poor in their view from management in the following areas Confidentiality of Resident information, Staff Conflict situations, Little Feedback from meetings. The care management team are currently addressing this with staff. It is of concern that some staff advised cleaning staff knew about resident admissions before trained staff in charge of a unit did and the daily reports on residents are read out in front of the housekeeper, kitchen manager and activities staff. Some staff believe this is an issue that concerns breach of confidentiality If correct, this would be considered poor practice and must be addressed by the care management team. Staff interviewed gave the impression they know a lot about the residents and their way with the residents was observed to be caring, knowledgeable and professional. Some staff were clear that Communication with themselves and the management team needs to improve, and the management team should consider ways in which they can do this. Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 2 x x Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 x x 2 3 LIFESTYLES Standard No Score 11 3 12 x 13 3 14 3 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score x 3 X X 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Avondale Nursing Home Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x 2 3 x x x 3 DS0000005451.V262438.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? 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 YA3 Regulation 14(1) Requirement Timescale for action 01/01/06 2 YA6 3 4 YA16 YA20 The registered manager must ensure all resident who live at the home are suitable to the homes registration categories. Those residents who were identified during the inspection as needing re assessment due to their physical health problems must have an assessment completed. 15(1) The registered manager must ensure that the new resident who has moved from another home to Avondale has an appropriate care plan and risk assessment in place. 13(1)(a)(b) The home must ensure residents privacy and dignity are maintained at all times 13(2) The home must ensure that all medication given is recorded and signed for by staff. This includes the recording of controlled drugs. The home must ensure that all medications have appropriate labels The home must ensure that 15/12/05 01/12/05 19/10/05 Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 25 overstocks and out of date medication are disposed of. The home must ensure that all medication is given as prescribed The home must ensure that liquid medications are dispensed accurately and that staff have the necessary equipment needed to do this. The home must ensure all staff are informed of ‘drug alerts’ that come to the home The home must review the way that medication is dispensed to residents so as to not encourage or promote institutionalised practices 5 YA23 18(1) The registered manager must ensure that staff have the appropriate Police and POVA checks in place before commencing employment. New staff working at the home must have two written references on file 13(4)(a)(b) The registered manager must ensure all staff can access room keys at all times. The registered manager must ensure that the fire door alarm system is repaired The registered manager must ensure that an audit is carried out regarding bedrooms that need replacement floor coverings due to cigarette burns. Replacements coverings to these rooms must be purchased The registered manager must DS0000005451.V262438.R01.S.doc 15/12/05 6 YA24 19/10/05 7 YA29 13(5) 01/01/06 Page 26 Avondale Nursing Home Version 5.0 8 YA35 18(1) ensure that all residents using wheelchairs have received and assessment of their needs and use an appropriate chair The registered manager must ensure that all staff are updated and trained on manual handling and abuse awareness 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA28 YA26 YA38 Good Practice Recommendations The home may wish to create a more homely environment for residents by adding pictures to corridor areas. The home may wish to provide staff with appropriate supervisor that is not just ‘clinical’ but covers areas of staff development The management at the home may wish to look at ways of developing communication within the staff team to make the team more effective and consistent Avondale Nursing Home DS0000005451.V262438.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 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 DS0000005451.V262438.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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