Inspection on 22/06/06 for Avondale Nursing Home

This inspection was carried out on 22nd June 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Avondale Nursing Home 14/06/07

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 Mrs Janice Patrick Key Unannounced Inspection 09:30 22 and 23rd June 2006 nd 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.V302786.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.V302786.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.V302786.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 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 a garden in the centre of the property. The home provides nursing care for elderly persons of which 5 beds a designated to the care of those with dementia The fee range for this home is £486.20- £622.01 Information from past inspection reports has not always been available to visitors within the home. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this inspection over two days. On the first day this was between 10.15am and 7pm. The newly appointed acting Manager was present including the newly appointed Care Services Manager. On the second day the inspection was between 10.50am and 7pm and the acting Manager was present. 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. Pre-inspection surveys were forwarded to the home for completion by relatives or representatives and twelve were returned to the Commission for Social Care Inspection (CSCI). These highlighted concerns that had already been identified by the company and the new acting Manager. This included poor communication with relatives and representatives, concerns regarding the past lack of competent home management, cleanliness of the home, numbers of staff on duty and lack of awareness regarding the complaints procedure. The majority also said they are always made welcome and eight were happy with the general care given. All Core National Minimum Standards (NMS) were inspected including 8 additional NMS. Past requirements made by the CSCI in accordance with the Care Home Regulations 2001 were discussed and had all been met. The following areas were therefore inspected. • A selection of key policies and documentation made available to residents and visitors • A selection of residents’ contracts and additional information • The home’s assessment processes, which included those carried out prior to admission • Care planning and any other care documentation • A review of residents’ health care • The medication system • Resident choice, preferences and the homes ability to be flexible • Food and kitchen environment including associated records • The home’s complaints system • How residents are protected from abuse • Private accommodation and communal spaces including maintenance and heath and safety records and practices • Infection control practices and general cleanliness • Staffing • Staff training and associated records • Recruitment practice Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 6 • • • • • The home’s management and communication How the home measures and reviews the performance of its services How the views of others on the services provided are gathered Records pertaining to residents’ personal monies General health and safety including arrangements for fire safety. Feedback on the findings of this inspection was given to the new acting Manager. What the service does well: What has improved since the last inspection? Since the appointment of the new acting Manager in April of this year and the appointment of the company’s Care Services Manager, many shortfalls have been identified and a process of rectifying these has begun. The following outline some of the improvements achieved so far: • The information that should be available to all prospective residents or their representatives and to existing residents has been improved upon and is due to be made available shortly. • • All contractual documentation and additional financial information is being collated for each resident and appropriately filed. The pre admission assessment process has been reviewed and all residents will receive an appropriate assessment prior to moving into the home. Additional assessments are being reviewed along with all care documentation. Residents (where able) and relatives are being actively encouraged to be part of this process. External health care professionals have been resourced as required and will continue to be actively involved in the health care of the residents. The medication storage area has been improved. Changes to some routines in the home and additional staffing is improving residents ability to have choice and the home to run for the benefit of the resident, not the other way round. DS0000055437.V302786.R01.S.doc Version 5.2 Page 7 • • • Avondale Nursing Home • A more robust complaints policy and procedure has been introduced and information pertaining to this will be going to each individual resident and or representative. Staff have received initial training in Adult Protection. Infection control practices and general standards of cleanliness have improved. Staffing has been increased and the recent recruitment of new staff has broadened the team’s skill mix. The home is being competently managed on a day-to-day basis and is regaining some stability. Arrangements have begun to improve the communication between the home and relatives/representatives. The home has commenced a system of quality assurance that is helping them to identify and monitor shortfalls in the service. Some areas have had action taken to improve them. General maintenance and health and safety practices are in place to provide the resident with a safe environment to live in. • • • • • • • What they could do better: Not all the care documentation has transferred to the newly introduced format. To ensure adequate and appropriate records are being maintained this needs to be completed as soon as possible. Specific ‘individual’ risk assessments need to be devised to ensure that some residents who are a cause for concern remain safe at all times. The home needs to take delivery of the new medication trolleys as soon as possible to improve the safety of the system. Some qualified staff may require an update in the principles of safe medication administration. Activities for those suffering from dementia need to improve. This would include the already identified need for a secure/safe garden. Records need to be kept of any foods provided for residents including alternatives to the main menu and any special diets. Improved practice relating to the Control Of Substances Hazardous to Health (COSHH) must take place. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 8 The home needs to reduce its dependency on agency staff and as part of its extended practice in protecting vulnerable adults, improve its recruitment practice. The home needs to improve its percentage of staff that hold an award at National Vocational Qualification (NVQ) Level 2 or equivalent and increase staff awareness in first aid and dementia care. 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 DS0000055437.V302786.R01.S.doc Version 5.2 Page 9 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.V302786.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 6 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. The information which is soon to be availble to exisiting residents, prospective residents and representatives is much improved and will provide the reader with all the information required. All residents and /or representatives receive a contract with additional information making them aware of any finacial commitment or entitled payment. All residents have their care needs assessed prior to moving into the home so as to ensure the home is able to meet their needs. New staff to the home are improving the skill mix and the ability for residents to have their needs met adequately, although staff skills/knowledge needs to improve in the case of dementia care. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home has a Statement of Purpose and Service User Guide. Some minor changes are required to these documents to bring them in line with Schedule 1 of the National Minimum Standards (NMS). Following this ammendments any adaptations required, such as large print, should be made. All residents and/or their representative must then be issued with a copy of the Service User Guide. A copy of the Statement of Purpose should be availvle in the home to anyone who wishes to read it. A copy of both must then be submitted to the Commission for Social Care Inspection (CSCI). These documents maybe subject to changes. The Administrator from the companys head office was able to confirm that all residents have a contract, although these are in the process of being updated. One resident’s file which had already been updated contained a social services contract. The administrator confirmed that not all social services funded residents would have received a copy of the home’s terms and conditions in the past. These will be included in the Service User Guide due to go out to all residents and relatives soon. She has also confirmed that headoffice is in the process of updating all residents’ files to include all financial details. These will include notification given of any fee increases. One file not updated as yet, contained a private contract dated 2003 with no reference to any changes in fees since. The letters informing the residents of a fee increase are held electronically and are later entered into the file, this is part of the file updating taking place. Registered Nurse Care Contributions (RNCC) are now paid directly into residents’ bank accounts, but the amount is still indicated on an invoice issued. An example of a new ‘Client Agreement’ was seen. No one has been admitted to the home since the last inspection in April of this year and some enqiries for dementia care have been turned down due to the number of residents currently suffering from dementia in the home already. The home is able to demonstrate that the skill mix of the staff is beginning to improve. The Manager is a registered mental nurse as well as a registered general nurse. One new registered nurse has specialised in the care of the elderly for over twenty years and for the past 5 years has held a management post in a care home for dementia care. There is a shortfall in dementia care training for most staff at the home and as the home has some beds dedicated to this type of care it is crucial that this knowledge is obtained. Access to this training was discussed during this inspection. Other members of the nursing team have some update training, but require updating in other areas. Two registered nurses are proficient in four layer bandaging to meet the needs of two residents with leg ulcers. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 12 Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Care plans are begining to improve, outlining the residents’ needs and giving guidence to care staff. Residents’ health care needs are being met. The medication system does not provide a safe system for administration. Staff ensure that the residents’ privacy and dignity is upheld. EVIDENCE: The care planning system was inspected and five care files had been updated and were seen to be in the new format. Three residents’ care files formed part of case tracking exercise. One of these was in the new format, vastly improved with associated assessments in place. The relative of this resident visited the home on one of the inspection days having requested access to his relatives care file. Another care file was read in the old format; although some care plans were updated the associated assessments had not been updated since changes in Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 14 this resident’s condition in April of this year. This was pointed out to the acting manager. There is possibly a training need relating to the writing of care plans. A further care file read indicated that this resident wandered most of the time during the day and this was observed to be so during this inspection. A night care plan says that the kitchen door must be locked at all times when not in use. This resident was observed entering the kitchen twice during the day when the cook was elsewhere. The Inspector was later informed that this resident has been known to leave the home via the kitchen back door and be found in the garden. There were no further risk assessments pertaining to this resident apart from the night risk assessment. Risk assessments within the old documentation format need to be reviewed to ensure the residents safety has been fully considered as a matter of urgency and any associated care plan devised. The Inspector is mindful that it will take time to transfer all general information over to the new format. The care documentation indicates that external health care professionals are attending to residents when required and that the home has several links with various agencies. Two recent complaints have had elements in them complaining that this has not always been the case. Following an investigation not all of these elements were upheld. During this inspection one resident explained that his General Practitioner (GP) had visited him recently. Another resident had also been appropriately medically reviewed following a recent decline in health. There were also records showing that the same resident had been seen by her GP in April and in May of this year. The Chiropodist has also seen her. The acting manager has called upon the services of the Tissue Viability Nurse to assess and advise on the care of one resident. The Community Psychiatric Nurse (CPN) is due to review a resident within the next week. The Learning Disabilities Nurse has been in contact with the home regarding one of the residents care. The Social Worker allocated to one resident has recently carried out a care review with the family present. There is evidence that residents’ continence needs are appropriately assessed by an external health care professional. New storage has been provided for medications and dressing equipment in an attempt to address the requirement within the last inspection report. At the time of this inspection the home was awaiting the delivery of a medication trolley. Due to the geography of the building it is not possible for this trolley to be used throughout the building. Administration practice was observed at the time of this inspection to be unsafe and therefore a requirement has been made, following advice from the Commission for Social Care Inspection (CSCI) Pharmacy Inspector, for the a further smaller trolley to be ordered, which can be used on the lower ground floor. This will avoid the unsafe practice witnessed at this inspection. At the time of this inspection the new storage area needed to act as a locked Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 15 medication cupboard in its own right, until further storage i.e. the trolleys arrived. This room was observed on several occasions as not being locked, with medication being stored on open shelves. Advice was given at the time of this inspection regarding locks to the door and automatic closures, which could be fitted to reduce the hazard. The acting manager was advised to complete a risk assessment on the present situation. The main storage cupboard must be fitted to a solid wall with two rag bolts via the back panel of the internal controlled cupboard. The Registered Provider has been informed of what is required to make the system safe. The Inspector observed staff being respectful of residents at all times. It was noted and reported to the acting manager that care files were left unattended for over 15minutes on the dining room table. This would constitute a shortfall in maintaining residents privacy and confidentiality. The acting Manager was to address this with staff following this inspection. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Making routines in the home more flexible is allowing residents to have more choice, although improved recreational opportunities are needed for those with dementia. Arrangements are in place to allow unrestricted access to friends and family and the involvement of representatives within the home is slowly improving. Arrangements are in place to ensure that residents are offered attractive and nutritious food, which meets with their own preferences and dietary needs. EVIDENCE: The staff were observed asking residents where they wished to sit, what they wanted to do, if they wanted to stay in their bedroom in one case or go to the lounge. One resident clearly has very specific preferences and these are met by the home well. He confirmed that he is able to go to bed and get up when he chooses. Another resident said she prefers to stay in her bedroom. Another resident likes to lie in the morning and is able to do so. One resident who prefers to stay in his room most of his time was seen downstairs expressing his choice for his tea. Other residents were asked what they would like for their Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 17 tea. The acting manager has commenced an activities file. Staff are being encouraged to write down what they provide each day and who has been involved in which activity. It was evident and confirmed by the acting manager that it would not be possible for staff to provide this if they were any less in number. One resident walked through the kitchen and out through the back door into the garden during this inspection. This resident has severe dementia and the grounds are not overly secure at present. A member of staff was seen escorting her on another occasion. Several residents particularly those who remain in their rooms enjoyed time in the garden recently. The acting manager has brought a gazebo to offer better sun protection and has requested that the company organise a secure area to the garden, which could be used by residents safely. She also confirmed that she has been allocated an amount of money for activities. A singer has been organised on a monthly basis, as this has proved very popular. The staff also provide music and movement on a regular basis. One resident has been into Cheltenham shopping for clothes with a member of staff Although this group of standards have been assessed as adequate the activities for those with dementia are not and the acting manager agrees that these need to develop. Several visitors were seen to be visiting their relatives and confirmed that they are free to visit when they choose. One visitor likes to take his relative out fairly frequently. This has been of some concern in the past as the resident gets very tired, but staff adhere to the wishes of the relative at the present time, but continue to monitor the situation. Relatives and representatives ability to obtain information about their relative and the home has not been good in the last year. Several have raised concerns relating to this either via a complaint or satisfaction questionnaire. A recent meeting was held to introduce the new acting Manager, including a relatives meeting to try and begin to address the communication shortfall. A relative that lives abroad had expressed similar concerns of which the management will start to address. Most of the residents in the home are not capable any longer of managing their own financial affairs, the acting manager confirmed that one resident organises all his own affairs, including payment of his fees. Another resident informed the Inspector that he was still well enough to do this for himself. Information on advocacy services is on the notice board in the reception area. It is evident in the home that many residents have brought in personal items or small pieces of furniture on admission. One relative had asked to see his relative’s care file and was doing this within the home on the day of this inspection. Residents who were able to pass comment on the food said that it is usually very good. One resident has very particular preferences and he explained that the cook was very good at meeting these. The cook described several of these preferences and clearly makes a particular effort to meet them. When asked Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 18 about having a choice several residents said the cook knows what I like and what I dont like. Additional supplements are provided for those at more risk of loosing weight. One resident is fed via a Percutaneous Endoscopic Gatrostomy tube (PEG) and is nil by mouth. Records of meals provided at lunchtime are normally kept but recently had not been. Longer-term records have not been kept of who is having what as an alternative to the main menu at lunchtime and who has what at teatime. There is no evidence to show that daily, weekly or monthly cleaning is being carried out, although the cook confirmed that it is being done. Fridge and freezer temperatures are being recorded. The acting manager has explained that the kitchen is an area that requires some refurbishment, particularly the dishwasher that apparently is not always cleaning the dishes properly. This is a potential health risk to elderly residents and must be addressed. Storage for food also seems to be a problem with several things spilling over into the staff room, some effort has been made to address this but the problem is not yet resolved. The Inspector observed two residents entering the kitchen, both were confused one carrying some clothing. This needs to be prevented for health and safety reasons. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 19 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Once appropriate addresses have been added to the complaints policy this provides the home with a satisfactory statement on how they are going to deal with complaints. Arrangements have been made to improve the staffs awareness of Elderly Abuse and how incidents are to be dealt with, thus offering the resident increased protection. EVIDENCE: There is a complaints policy within the company policy file which is extremely brief. Consideration has been given to this by the acting manager and care services manager and a temporary, more detailed policy with a written procedure, put within the Service User Guide for Avondale. This requires some minor changes to ensure the reader is aware of the CSCIs address and the address of the local Adult and Community Services (Social Services) office. It is then intended that these will be distributed. The home management are also discussing a proforma which will guide staff through the process of receiving an allegation and concern. A copy of the temporary complaints policy/procedure was also seen in the reception area but again this requires ammendments to the addresses and consideration needs to be given as to whether residents can read this as it is in very small print. The home has recently completed the investigations of two complaints. This process was not within the 28 days as stated within the complaint policy for Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 20 various reasons of which the CSCI are aware, but were completed thoroughly. One complainant is satisfied with the outcome of the investigation. The other complainant has not yet been in contact to express whether they are satisfied or not. There is now a complaints log within the home for recording formal complaints. A record of informal complaints was also seen. The acting manager wishes there to be an additional, uncomplicated way for visitors to express any concerns or even compliments. Therefore she is in the process of devising a simple format for Compliments, Concerns and Complaints, which will sit in the reception area. Two visitors spoken to during the visit were aware of the complaints procedure in the reception area. Out of twelve pre inspection surveys completed by relatives and forwarded to the CSCI, five said they were unaware of the home’s complaint procedure and one aware only recently since the new acting Manager has been in post. Again within the company policy file is a policy called Managing Third Party Abuse of a Service User. The acting Manager is concerned that a member of staff needing to find this policy urgently may not relate to its title. The Policy within the file is headed Protection of Vulnerable Adults (POVA). The policy does reference the DoH Document No Secrets and the Gloucester POVA Policy. Most staff received training on this subject on 27/2/06, those that did not will receive a training session in the near future. The record of staff names attending was seen and the content of the training read. The home also has a whistleblowing policy. Some staff are new and are not aware of this as yet. The acting Manager will ensure that all staff become aware of key policies and arrangements for regular updates in these will be arranged. POVA is discussed in a staff member’s induction training. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25 & 26 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the home which will help it be more organised internally. Once external changes have been made to the garden, this will help to enhance the residents’ safety and their lives. Infection control practices have improved and residents are benifiting from living in a clean and airy environment. EVIDENCE: The home looks well maintained both inside and outside. Internally it is laid out on four levels. A few steps only separate two of these levels but this can cause organisational problems for the manager at times. The call bell system is extremely loud and intrusive and consideration should be given to an alternative sound. The front reception area has improved and looks welcoming, although on entering there was an obvious odour. This was discussed with the acting Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 22 Manager who would review how one particular resident’s continence was being managed following this inspection. A further structural change to the interior has been the completion of a much needed nurses’ office and medicine storage area. This has been built into the end of the lower ground floor communal room, but this room remains a spacious and airy space for residents to enjoy. Several bedrooms were inspected. These looked clean and varied in how residents and their families had personalised them. All bathrooms and toilets were inspected. These offer a variety of assisted or non-assisted facilities. The home also has a shower on the ground floor. These were clean and located near to bedrooms and communal rooms. Various pieces of specialised equipment are present in the home designed to make residents lives more comfortable, safer and to protect staff when carrying out a moving and handling procedure. These include a special bed, which lowers to the floor, crash mats, bed rails and mechanical hoists. The kitchen was inspected. This is small and has a staff room located off it, which is not ideal. Storage has been a problem with some spilling over into the staff room, but this may improve now the nurses’ office, originally next door to the kitchen, has been relocated. Temperatures of fridges and freezers are being monitored. There is no recorded cleaning schedule, although the cook confirmed that various tasks are carried out. The kitchen looks tired although only re fitted two or three years ago and a comment was made to the Inspector regarding the inefficiency of the dishwasher. The Inspector understands this has been passed onto the Registered Provider. Cleaning products were seen stored in the cupboard under the sink but this cupboard had no means of being secured. The laundry is located outside the building and has been furnished with shelves since the last inspection. This was clean and organised; although some soiled washing was observed to be loose on the floor attracting flies whilst other washing was secure in bags. The sluice facilities are also located outside which really complicates the practice of emptying commodes etc. This was clean and organised. This facility is not used at night for security reasons. Plastic aprons and gloves are available for staff to wear when needed. The home has appropriate clinical waste arrangements in place. The sluice room was unlocked at the time of this inspection and staff need to be aware of the safety of residents who may wander into the garden as this room also acts as the home’s storage area for chemicals hazardous to health. The acting Manager has identified the need for an enclosed garden area so that the more confused resident can go outside and remain safe. She hopes that this may be achievable for this summer. A gazebo has been purchased to offer shade to a larger number of residents. The company employs an Estate Manager who is responsible for coordinating all health and safety requirements. This also includes anything related to fire safety. He organises and co ordinates all maintenance within the company’s Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 23 portfolio of homes. There is a rolling programme of works including day-today maintenance and the home meets with any requirements made by the Fire Officer. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. Residents are benefiting from the increased staffing levels, although recruitment of permanent staff remains a problem. The residents would benefit from more staff being trained to NVQ standards, but this will only occur when the home has recruited more of its own staff. Due to a lack of appropriate delegation within the company it has been difficult for them to prove that robust recruitment practice has been carried out and therefore demonstrate that residents are being adequately protected. The organisation of basic training for staff is beginning to improve, however, the home needs to ensure that good practice is maintained during a period of high dependability on agency staff. EVIDENCE: Since April 2006 staffing levels have been increased to meet the needs of the residents. At the time of this inspection the home had one vacant bed, already booked. The home currently works with 4 care staff and one qualified nurse in the mornings, from 08:00hrs and in the afternoon the same until 8pm. At night there is 1 qualified nurse and 1 carer. The new acting Manager feels this staffing is adequate at present, but also feels that if the needs of the residents were to increase the staffing numbers would need to be reviewed. At the present time many residents choose to go to bed before 8pm or are Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 25 extremely frail. The Inspector was informed that no residents wander on a regular basis at night. The acting Manager also confirmed she is able to meet the residents’ recreational and social activity needs with the above staffing levels, although she has identified that these need improving for those with dementia. Off duty rosters were seen planned up until the 16/7/06. Several hours per week are covered by agency staff who have been block booked ahead to aid continuity. At the present time only one registered nurse for night duty is employed by the home. Similarly, agency staff are being block booked to aid continuity on nights and several day agency staff, who know the residents will also work night duty. Although the Inspector has recognised that the acting Manager is trying to maintain continuity during a time when there is a high dependency on agency staff, she must be sure that all staff have the required knowledge to meet the needs of the residents and maintain their safety. One agency carer confirmed that they had received moving and handling training via the agency. They did however confirm that this home had not explained what to do in the event of a fire or pointed out where the fire points were. This carer had also received no training in the care of those with dementia from the agency and had little practical experience in this field of care. The home should give serious consideration to making arrangements for agency staff to receive a briefing on basic information when they commence a shift at the home and that a record is kept that this information has been given to them. The home has one carer that holds the NVQ Award Level 2. Two further carers have started Level 3. The company has recruited one new Registered Nurse since April 2006. Not all the paperwork pertaining to her recruitment was available within the home for inspection. The companys head office was contacted and there appeared to be great confusion regarding the whereabouts and status of the recruitment file. Since this inspection it has been necessary for the company to request references again on behalf of this employed person. The Inspector has concluded that either poor recruitment practice was original used or the department within the company responsible for pre employment paperwork is extremely disorganised. The confusion relating to who has responsibility within the company to complete the recruitment process has been going on for sometime now and must be addressed to avoid further action by the CSCI. This has been highlighted with the Registered Provider seperately to this report. Since this inspection the CSCI have been assured by the newly appointed Care Services Manager that this will not occur again and that the responsibility for recruitment has returned to the home Manager. The company were requested to provide the CSCI with copies of the refrences for their latest recruit, which they have subsequently done. Recruitment files pertaining to care staff employed earlier in 2006, but who have since left, demonstrated that appropriate recruitment practice had been Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 26 followed. Evidence that CRB clearence’s were obtained, again was not availble in the home but later seen in an additional folder obtained from the company’s headoffice. In order to demonstrate good interview practice and Equal Opportunities the acting Manager will be introducing an interview questionnaire record. Two further overseas staff were due to start work in the home mid July, again there was great confusion as to where the recruitment paperwork was for these staff and what stage of the recruitment process had been reached. Subsequently their recruitment has been postponed until the acting Manager has been assured that all recruitment criteria has been met. Staff files showed that most staff had received an induction period of training on commencing in post. Records demonstrated that most staff employed by the home are fully up to date in moving and handling and fire awareness. Other manadatory training need reviewing and updating, such as food hygiene and first aid awareness. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. The running of the home and resident care is benefiting from having a competent acting Manager in post who is communicating her vision to both relatives and care staff, and who is aiming to improve the service all round. Arrangements are in place to measure the quality of services and care being provided. Residents can be assured that their personal monies are safe. The arrangements to ensure residents health and safety are improving. EVIDENCE: Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 28 The present acting Manager has been in post since early April of this year. She is a well-qualified and broadly experienced nurse who also has been registered with the CSCI as a Registered Manager elsewhere in England. The CSCI have now received her application for Registered Manager of Avondale. Along with the newly recruited Care Services Manager they have been effective in sorting out many issues within the home that were the result of poor or absent management over a long period of time. It has been crucial to improve communication with residents, representatives and staff. This was one of the elements within the complaints received and has been commented on within the pre inspection surveys forwarded to the CSCI and within other communication received by the CSCI. An initial meeting was held by the Registered Provider so as to introduce the new acting Manager and since that a relatives meeting has been held. Evidence from this inspection would suggest that this is beginning to improve. Ongoing dialogue between the acting Manager and the Inspector ensures that the CSCI are aware of the home’s progress. This also enables the Inspector to offer support as the acting Manager endeavours to meet the National Minimum Standards (NMS), The Care Home Regulations 2001 and improve the service. The home has a quality assurance system that was set up a while ago. This already includes various completed audits. A medication audit was carried out in February 2006, accidents and incidents had been audited for the period of October 2004- May 2006, wound care; infection control and record keeping were all audited in February 2006. Auditing of accidents and falls have continued on a monthly basis. An external company carried out an audit on beds and mattresses recently and the pressure relief needs of the current residents has been reviewed with the Continuing Health Care Nurse. Satisfaction questionnaires were sent to relatives in February 2006. 19 were sent out and 12 completed forms were returned. A relative in consultation with a resident completed four; seven were completed by a relative on behalf of a resident and one by a service user alone. Six services offered by the home were highlighted for consultation these included: the residents’ individual accommodation, the communal spaces, the general facilities and services provided, the standards of care, staffing, visiting and relatives general views. Overall scores were satisfactory 83 , unsatisfactory 8 and no comments 9 . These results will be placed on the home’s notice board. The CSCI sent out 20 pre inspection relative survey forms of which 12 were returned. These identified many of the concerns that had already been identified by the new management and included: lack of communication between staff and relatives, poor staffing, inadequate activities and a poor awareness of the complaints procedure. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 29 A letter received from a relative following the relatives meeting speaks highly of the positive attidude now being shown and the friendly manner exhibited by staff. Small amounts of personal monies are held safe for fifteen residents. Nine ‘in house’ accounts were inspected and records seen corresponded with the amounts of monies held. Receipts are also kept which included those for Chiropody. Records were seen of various health and safety checks and the servicing of equipment such as; gas and electrical checks, lift maintanence checks, hoist servicing, lighting and hot water temperature checks. A bathroom had been identified as requiring a hot water blender to keep the hot water temperature within a safe range of 43° Celcius. All checks regarding the fire alarm system have been recorded. The Fire Risk assessment was seen but did not yet include individual staff competency when it comes to fire awareness. The acting Manager confirmed that the Estate’s Manager is fully aware that there is soon to be new regulations pertaining to this and is planning to address these on his return from holiday. Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 30 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 2 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X 3 X 3 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 X X 3 Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 4(2) 5(2) 6(a) Requirement The Registered Person shall ensure that a copy of the Service User Guide is issued to all residents and/or their representative. A copy of the Statement of Purpose must be available in the home for anyone to read. A copy of both documents must be forwarded to the CSCI and kept reviewed and amended as required. The Registered Person must ensure that all care staff have knowledge in dementia care. The Registered Person must ensure that each potential hazard to a specific resident is formally risk assessed and any potential danger to them is reduced. Timescale for action 31/08/06 2. 3. OP4 OP7 18(1)(c) (i) 13(4)(b) 30/09/06 31/07/06 4. OP9 13(2) The Registered Person must 31/07/06 ensure that the back panel of the controlled medicine cupboard is fitted to a solid wall with two rag bolts. Through the use of appropriate storage and update training DS0000055437.V302786.R01.S.doc Version 5.2 Page 32 Avondale Nursing Home ensure that the principle of safe administration is practiced. 5. OP12 16(2)(n) The Registered Person must take into regard the needs of the residents with dementia and provide appropriate activities, recreational opportunities. The Registered Person must put into place arrangements, which meet with guidelines under the Control Of Substances Hazardous to health. The Registered Person must ensure that records are kept of any food provided for the residents and of any special diets prepared. The Registered Person must ensure that each resident receives a copy of the homes updated Complaints Policy and he or she is made aware of the procedure for making a complaint. The procedure must contain the right names and addresses of those agencies that a complaint can be made to outside of the home and be in a format suitable to the residents’ needs. The Registered Person must ensure that any temporary staff working in the home are provided with adequate knowledge so as not to compromise the safety of or the care of the residents. The Registered Person must demonstrate that the home is aiming to have at least 50 of its care staff trained to NVQ Level 2 or equivalent. The Registered Person must demonstrate that robust recruitment practice, as laid down within the Care Homes DS0000055437.V302786.R01.S.doc 31/08/06 6. OP15 13(3)(4) (c) 31/07/06 7. OP15 17 Schedule 4(13) 22(5)(7) 31/07/06 8. OP16 31/07/06 9. OP27 18(1)(b) 31/07/06 10. OP28 18(1)(c) (i) 31/08/06 11. OP29 19 31/08/06 Avondale Nursing Home Version 5.2 Page 33 12. OP30 13(3)(c) Regulations 2001, is being applied in all cases of prospective employees. The Registered Person must provide all staff with training in first aid awareness. 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Avondale Nursing Home DS0000055437.V302786.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 DS0000055437.V302786.R01.S.doc Version 5.2 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!