Inspection on 04/01/06 for Avondale Nursing Home

This inspection was carried out on 4th January 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Avondale Nursing Home 14/06/07

Avondale Nursing Home 22/06/06

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 Unannounced Inspection 4th January 2006 10:30 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.V269861.R01.S.doc Version 5.1 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.V269861.R01.S.doc Version 5.1 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 01242232012 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.V269861.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2005 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 safe, contained garden in the centre of the property. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one Inspector between the hours of 10.30am and 2pm. At the same time as the Inspector, senior representatives of the company arrived at the Home, later joined by the previous Registered Manager of Avondale who has been monitoring the Home in the absence of the acting Manager. Previous requirements made by the Commission for Social Care Inspection (CSCI) were discussed and the progress evaluated by the Inspector. A tour of the ground floor was carried out during the course of the inspection. Several residents and staff were spoken to. Care documentation was inspected in detail, with an emphasis on care planning and assessment processes. The medication system and relevant records were inspected. The dietary requirements of those most vulnerable were discussed and inspected. What the service does well: What has improved since the last inspection? What they could do better: Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 6 The Home is in need of competent day-to-day management; many systems are not running smoothly or meeting the Care Home Regulations 2001 because of a lack of direction and delegation. The pre admission assessment process is not being adhered to and requires improvement. Care planning is not meeting the requirements for ‘best practice in recording’ and staff are not relating to them when delivering residents’ care. The medication system needs organising and ensuring it is totally safe. Staff require further knowledge and awareness on Adult Protection and Elderly Abuse. The staff team requires continuity and good leadership to become an effective, cohesive team again. A quality assurance system is required to help the Home reflect on, review and improve care practice and the services it provides. Staff require supportive and structured supervision to ensure they are practising as required and for their professional development. Available risk assessments need to be completed appropriately to identify any risks to a resident, help guide staff and demonstrate how the risk is being managed and reduced. 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.V269861.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 EVIDENCE: The Inspector looked at four residents care documentation in detail. Three of these residents had been admitted to the Home without a completed pre admission assessment being completed. All three residents had assessments completed once admitted to the Home, although none of these were dated. One had accompanying information within a hospital discharge letter, but this only gave information relating to her stay in hospital and another appears to have been admitted directly from her Home with no pre admission assessment. It was evident within the care documentation that one resident was extremely unstable mentally. Due to a lack of correct pre assessment process this was not identified and the Home struggled to meet her needs following admission. This Home does not provide specific intermediate care. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 9 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, 9 & 10 Due to poor care plan documentation the Home is unable to demonstrate how it is meeting the residents’ needs. The systems for medication administration are disorganised and potentially place residents at risk. Personal care and support is offered in such a way as to promote residents’ privacy and dignity. EVIDENCE: The care plans and other care documentation of four residents were inspected in detail. All four had care plans, which varied from being informative to extremely weak in their content. Several were not updated since October 2005. The majority either had no further written information apart from the identified care plan or had entries such as: ‘seen by GP, to review medication in one week’ (dated 17/11/05) with no further reference to this seen in any documentation. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 10 Another care plan had no date and identified that the resident’s eating was extremely compromised and a referral should be done to the dietician, this was on the 29/11/05 with no further entry seen. Care assistants keep a diary of events within these notes, but these refer mainly to the basic care given and are not entered necessarily on a daily basis. With reference to the resident who had been identified as not eating well, care notes had been kept from her admission up to 1/1/06 (last entry seen) but there was no reference to her eating or drinking. The Inspector spoke with one care member and asked her how she was aware of a resident’s care needs and how these were to be met. She explained that staff do not look at the care plans, but rely on direction from the qualified nurse. One particular care plan was discussed with her and she was asked, from the information written, would she know how to deal with the behaviour that was being exhibited. In her case she explained she was relatively experienced and would get by, but she agreed that an inexperienced or unfamiliar member of staff would not get any guidance from the written content. She was also unfamiliar with the care plan. The above is unacceptable and does not legally meet the requirement laid down by the Care Home Regulations 2001 or the Nursing and Midwifery Council. It does not demonstrate how care needs are being met and places the resident at risk. The medication system was inspected. This had been inspected by the one of the Pharmacy Inspectors attached to the CSCI earlier in 2005 and was satisfactory with only a few recommendations made. On this inspection the storage area was very disorganised, grossly over stocked and stock belonging to deceased residents was still evident. Several packs of the same eye drops were open with no opening date; bottles of medication had been commenced with no opening dates and three very full sharps containers were present. The medication fridge was above its optimum temperature. This is either because it requires defrosting or the lack of ventilation, in what effectively is a walk in cupboard, is not adequate to keep the environment cool. Drug administration records (MAR Sheets) were inspected. These had been filled in appropriately each time a medication had been administered, but showed that hand written directions were not being signed or counter signed. It was agreed at this inspection that the previous Registered Manager would complete an audit and take appropriate action. During this inspection staff were seen and heard to be speaking to residents in a respectful manner. One carer was heard to lower her voice in one of the communal rooms when asking a resident if they wished to use the toilet. One resident was observed to be getting a lot of support at lunchtime, but in a way that would not embarrass her. Another resident felt that the staff were always polite. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 11 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): 14 & 15 Residents are, within the constraints of their health, encouraged to make choices and have some control over their lives. The meals in the Home are good, offering choice and variety and catering for special diets. EVIDENCE: It was evident by observation and listening that many residents are extremely dependant on the care staff for all their daily needs. However, one resident was able to explain how he prefers to sit in his room initially and then join others for lunch or activities. Other residents appeared to stay in their bedrooms on the day of this inspection and took their lunch there as well. This was not explored at this visit. Another resident, clearly very confused, was allowed to carry on organising her bedroom freely but at lunchtime was gently reminded of the time. At lunchtime the Inspector observed the very fine balance of negotiation and encouragement when a carer was trying to achieve some degree of dietary intake with a resident, but without encroaching on the residents choice of initially not wanting to eat. This was done over a period of forty minutes with great patience and a little success. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 12 Although the menu blackboard in the dining room showed what was for lunch, it did not indicate any options. However, both staff and the residents confirmed that the cook knew everyone’s likes and dislikes and cooked around these, providing different individual options daily. One resident said the food is always lovely and there is usually too much. The kitchen was seen briefly and looked organised, it is still however, the only route to the staff room. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 13 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): 18 Protection for vulnerable residents within the Home will be enhanced when the company starts to provide training on Adult Protection and Abuse. EVIDENCE: There was no evidence to suggest that the Home has an abusive culture during this visit, in fact residents spoken to said they were happy and that staff were very kind. There is no history of reoccurring complaints or any other situation reported to the CSCI to suggest such an environment. One of the representatives of the company explained that training on Adult Protection and Elderly Abuse was due to commence in February of this year. As yet staff have not received designated training on this subject for sometime. The CSCI, in conjunction with the Adult Protection Unit and the Police will be launching new guidelines and training in this commencing in April 2006. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 14 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 & 26 The standard of the residents’ accommodation is good in this Home providing them with a pleasant and clean environment to live in, although some areas look a little sparse. EVIDENCE: The general maintenance and decoration of the Home is good. Residents’ private accommodation shows signs of some residents bringing in small pieces of their own furniture and belongings. One resident was an artist and has his own artwork around him, which he takes much pride in talking about when the Inspector visits him. Another lady chose the colour of her bedroom. The Home ensures it meets with the Fire Officer’s recommendations. A bolt had been fitted to the ground floor external fire doors as one resident was exiting the building in a very confused state. Signs were present to draw attention to this, but possible use of keypads and further consultation with the Fire Officer was discussed as necessary at this inspection. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 15 The Estate Manager for the company is responsible for developing an annual plan for the Homes maintenance and decoration works. The Home looked clean and was free of offensive odours. The laundry was not inspected during this visit. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 16 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 Although the Home has a core group of staff committed to the care of the residents, the Home is still going through a period of instability in order to achieve an adequate skill mix. EVIDENCE: The previous Registered Manager and the Provider have assured the Inspector that the Home is staffed with enough staff to meet the needs of the residents and to ensure their safety. A carer spoken to agreed with this, but also confirmed that it has been very difficult recently when the care needs of a one resident increased, but the staffing numbers remained the same. This resident’s care documentation would suggest that she was at risk at certain times. At present the qualified nursing team is being supported by transferring a nurse from one of the sister Homes to cover some shifts and by another existing nurse, agreeing to cover extra shifts. The Registered Nurse on duty during this inspection had been with the Home for two months. It is evident by inspecting various systems within the Home and by reading the care documentation that there is a lack of direction and delegation amongst the senior team. This is resulting in a lack of direction for the core staff. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 17 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, 33, 35, 36 & 38 The Home is not managed on a day-to-day basis effectively enough to ensure residents are benefiting from a Home that is well organised and where staff are receiving adequate leadership. The Provider has a good understanding of where the Home needs to improve, but as yet there is not an adequate system in place to allow review, evaluation and consultation of the Home’s practices and to allow them to move forward. Staff are not appropriately supervised to ensure that residents’ needs are being adequately met or to ensure they are consistently working in a manner that ensures that all health and safety and other policies and procedures are being adhered to. EVIDENCE: The acting Manager at the time of this inspection was on maternity leave. The previous Registered Manager transferred to a larger sister home within the Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 18 company in August 2005, although she has been offering guidance to the acting Manager of Avondale. Over the last few months this support has been slowly withdrawn. Some concerns were raised by the Inspector during the last Inspection and reflected within the requirements made in the inspection report. During this inspection, it was clear that the Home is suffering from a lack of day-to-day leadership. This has been discussed with the Provider who must address this immediately. The staff group have not received structured supervision for sometime. The previous Registered Manager informed the Inspector that she plans to instigate this in the very near future. The Provider was reminded that this has been a requirement for sometime now and must be addressed to avoid further action by the CSCI. The Inspector is aware that a Quality Assurance System has been devised and understands this is to be implemented soon. Proof of the company’s financial viability has not been requested by the CSCI in 2005. The Inspector is aware of several other development projects that have taken place successfully within the company and observes that all Homes belonging to the company are well maintained, are consistently warm and well staffed. Staff at Avondale have recently been updated in moving and handling. There were no records of this within the Home, but it is understood that twelve staff members received this training, of which a list is at present maintained at the company’s head office. This will be requested by the CSCI in the future, but one member of staff confirmed that she and several others had received this training in December 2005. Moving and handling risk assessments seen at this inspection were either behind in review or were not dated. The Inspector was informed that all staff were now up to date in Fire training. One resident’s recent disturbed behaviour affected both her own and others safety, but there were no risk assessments in place to show how this was being managed and the risk to her safety reduced. Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 2 Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The Registered Person must ensure that the Home carries out a comprehensive pre admission assessment to ensure the needs of the resident can be met by the Home. (Timescale of 01/01/06 not met) The Registered Person must ensure that each care/health need has a clear plan of care, that where practicable there is consultation with the resident/representative, that it gives clear guidance to staff as to how that need is to be met and it is reviewed regularly or as needed. (Timescale of 01/01/06 not met) The Registered Person must ensure the medication system is organised and safe. The Registered Person must make arrangements by training staff or otherwise to prevent residents from suffering harm or abuse. The Registered Manager must provide enough staff in number and skill mix to ensure the needs DS0000055437.V269861.R01.S.doc Timescale for action 28/02/06 2 OP7 15(1)(2) 28/02/06 3 4 OP9 OP18 13(2) 13(6) 01/02/06 28/02/06 5 OP27 18(1)(a)& (b) 01/02/06 Avondale Nursing Home Version 5.1 Page 21 6 OP31 7 OP33 8 OP36 9 OP38 of the residents are met at all times. And, that any temporary arrangements do not affect the consistency and continuity of the care provided. 8 (1a & The Registered Person must b)(i/iii) appoint an individual to manage the care home on a day-to-day basis. 24(1/2/3) The Registered Person must maintain a system for reviewing and improving upon care and services provided by the Home. And: Supply a report in respect of the above to the Commission. And: Achieve this through consultation with the residents, their representatives and other visitors to the Home. 18(2) The Registered Manager must demonstrate that adequate supervision is being afforded to all staff within the care home. (Timescale of 01/01/06 not met) 13(4)(c) & The Registered Person must 13(5) ensure moving and handling and general risk assessments are devised and reviewed as required. 01/02/06 28/02/06 01/02/06 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 Refer to Standard OP36 Good Practice Recommendations A record of the date and subject covered in supervision should be signed by the recipient and kept within the Home’s staff file. This should be at least six times a year or more if required. DS0000055437.V269861.R01.S.doc Version 5.1 Page 22 Avondale Nursing Home Avondale Nursing Home DS0000055437.V269861.R01.S.doc Version 5.1 Page 23 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.V269861.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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