Inspection on 06/02/06 for Avondale Nursing Home

This inspection was carried out on 6th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 6 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 19/10/05

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 6th February 2006 10:00 Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 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.V282675.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 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.V282675.R01.S.doc Version 5.1 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.V282675.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to Include up to 50 (MD) Date of last inspection 19th October 2005 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.V282675.R01.S.doc Version 5.1 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. The inspector arrived at the home at 10.30 and left at 15.45.The inspector spoke to the deputy manager, the finance manager, six care/nursing staff and six residents. The inspector 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 inspector 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 deputy manager during and at the end of the inspection. Not all standards were assessed during this inspection, however the home has been assessed against all the core standards during the 2005/6inspection year. What the service does well: What has improved since the last inspection? What they could do better: The registered manager must ensure that staff adhere to guidelines on the administration of medication. This area has been highlighted as a concern in past inspection reports, a pharmacy inspection and during this visit. It is Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 6 concerning that despite immediate requirement notices, pharmacy advice and staff training, serious errors are still occurring. Recruitment practices at the home must improve to ensure all staff that work at the home are suitable to do so. Nurses employed by the home must hold current registration with the Nursing and Midwifery Council. Staff must ensure they seek the views of the residents, and where possible their signature to agree their care plans. Residents must be kept informed of any changes made. The registered manager must ensure that all aspects of the home are kept under regular maintenance checks for wear and tear, in particular the red lounge. Residents must be able to keep drinks in clean and suitable areas rather than dirty ashtrays and the home may wish to review their current domestic cover to ensure the home is kept clean. The registered manager must ensure that any incident at the home that affects the well being of residents is reported to the Commission for Social Care Inspection via a ‘notifiable incident form’. 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.V282675.R01.S.doc Version 5.1 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.V282675.R01.S.doc Version 5.1 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): EVIDENCE: None of the above standards were assessed in full Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 9 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 Care plans do not demonstrate that residents are involved in planning and developing their own plan of care. EVIDENCE: Four care plans were looked at during the inspection. Plans are individual and detail what a resident can or cant do for themselves. Details of the input needed by staff are also recorded so they are aware of their roles and responsibilities to each resident under their care. Plans showed that residents are not being involved in the planning of their care and had not agreed the plans formulated on their behalf. One plan looked at had details of a ‘rehabilitation plan’ however this was only half completed and another plan had not been signed on all pages by the nurse who had written the care plan to identify who had devised the care needed. Residents spoken to during the inspection were not aware that they had a ‘care plan’ or what it detailed about them. Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 10 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): EVIDENCE: None of the above standards were assessed in full Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 11 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): 20 The home has failed to improve their procedures for administration and recording of medication, leaving residents at risk of harm. EVIDENCE: Staff discussed the training opportunities that they had been given regarding medication practices since the last inspection. Feedback was positive, and comments were made that it was “more aimed at a trained nurse that previous training” and “well worth attending”. Staff also commented that despite previously raising the issue with the general manager, they were still experiencing serious problems with the outside pharmacy that supply the home, examples were given as to how this had effected the running of the home. A ‘medication-working group’ has also been set up to deal with any issues arising from this area, including that of the supplying chemist. The lunchtime medication round was observed being given from the main clinic room. As in previous visits, a long queue of residents was formed along the corridor as medications were given out. This does not promote dignity or confidentiality for residents. Medication records (MAR charts) were checked. Photographs had been put in records as a form of identification and medications are signed as they are checked into the home. Despite training and staff council ling, medication practices were still unacceptable. The following errors were identified: Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 12 1.Resident 1, had been prescribed one or two painkillers four times a day and was only being given them three times a day. The doses that had been given were not recorded and it could not be determined how many of the tablets had been taken. 2. Resident 2, was prescribed Lactulose twice a day, but had been given it three times a day for three days. 3. Resident 3, was prescribed Fibrogel once per day but had been given it twice a day for seventeen days. 4. Resident 4, did not have the doses of Senna identified to show how many tablets had been given. 5. Resident 5 had 8 doses of Calogen and 8 doses of Ensure out of stock. This is particularly important to this resident who needs specific nutritional support as to maintain their health. 6. Resident 6, did not have the doses of Senna identified to show how many tablets had been given. 7. Resident 7, was prescribed 2.5 mls of Peptac liquid four times a day, but was only being given this twice a day for the month of the records. These further errors were fed back to the deputy manager to deal with as a matter of urgency as residents were continued to be put at risk. Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 13 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): 23 Checks on staff do not ensure that residents remain protected from harm. EVIDENCE: Four staff files were looked at and were found to contain information regarding induction, references and interview check lists. One file did not contain a photograph of the member of staff as a form of identification, and another had no CRB (criminal record check) or POVA (protection of vulnerable adults) checks in place. The home did not therefore know if the staff member was suitable to work with vulnerable residents. This requirement remains outstanding from the last inspection report, and is of concern that this practice is continuing. The home has a list of the PIN (personal identification numbers) for all registered nurses working there. This list is a recorded complied by the home and had not been checked with the Nursing and Midwifery Council to verify if the PIN numbers were valid and authentic. Records for four members of staff showed that their PIN numbers had expired. The deputy manager explained that the home had written to these nurses to ask for confirmation of their new PIN details, however two staff files sampled for these nurses showed no evidence of these letters. Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 14 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 and 30 The overall quality of some lounge and corridor areas at the home is poor and is not creating a pleasant environment in which to live. Staff and residents feel that the cleanliness of the home needs to be improved. Details of incidents effecting residents well being have not been sent to the Commission for Social Care Inspection, which could leave residents at risk from harm. EVIDENCE: A tour was undertaken of the home. Residents sitting in the red lounge had to balance their cups of tea inside dirty ashtrays, which had been identified on the last inspection. The lounge had four seats that had cigarette burns in them and the arms of one of the sofas was frayed. These seats need replacing so as residents have a comfortable and homely area to sit. One resident was sitting in this lounge with a heavily food stained t-shirt and another lady had holes in her socks. These concerns were fed back to the deputy manager at the time. The corridor carpet outside the red lounge was also identified as needing replacement as it also was heavily stained with cigarette burns. Two area of the home were being redecorated following a flood, the deputy manager this was currently being addressed. Staff and residents were asked if they felt the Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 15 home was kept clean. Comments were made such as “It should be cleaner, but there are enough domestics”, “not as clean as it used to be” and “the cleaners don’t have enough time and standards need to improve.” The deputy manager explained that the home are currently reviewing the ‘domestic’ cover at the home and looking at putting extra staff on during busy periods. Discussion with staff highlighted that the home had recently had a flood, the electrics had gone off, the fire alarms and nurse call bells had failed to work and a break in had occurred. None of these incidents had been reported to the Commission for Social Care Inspection using a ‘Notificable Incident Form’. The deputy manager was asked why this had not been carried out and he replied that he was not aware that these issues needed to be passed on. Advise was given regarding notificable incidents and what needs to be reported to the inspector. Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 16 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): 34 EVIDENCE: The home has an equal opportunity policy in place, which is used when recruiting staff. Staff confirmed that they had been given terms and conditions of employment and had received a full induction about how the home operates and the residents that live at the home. All staff files sampled contained two written references detailing the ability and reliability of staff. Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 17 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): 37 Communication between the management team is developing, however staff must feel free to express their opinions without fear of reprisal. EVIDENCE: The homes registered manager is a qualified nurse and has many years experience in caring for adults with mental health problems. The manager holds an NVQ level 4 in management and is supported by a team of other managers within the home. Since the last inspection, some staff commented that, in their opinion, communication between the manager and themselves had improved; others did not share this opinion. Comments were made about there being “too many office based managers” that were not aware of day-today problems. Some staff made comments about how they felt unable to speak freely to inspectors, as following the last inspection staff were interviewed by the board of trustees following negative comments that had been made. The manager must expand on the developments he has put in place and ensure that effective communication and consultation is promoted. Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 18 Avondale Nursing Home DS0000005451.V282675.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 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 Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 1 X 2 X X X X X X Avondale Nursing Home DS0000005451.V282675.R01.S.doc Version 5.1 Page 20 NO 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 YA6 Regulation 13 Requirement Timescale for action 01/04/06 2 YA20 3 YA23 4 YA24 The registered person must ensure that residents are involved in all aspects of planning their care. 13(2) The registered person must ensure that all medications are administered as detailed on the prescription label. The registered person must ensure that all variable doses of medication are recorded correctly. Outstanding from previous report: previous timescale 19.10.05 18(1) The registered person must ensure that staff has the appropriate Police and POVA checks in place before commencing employment. Outstanding from previous report: previous timescale 15.12.05 The registered person must ensure that registered nurses have an active registration with the Nursing and Midwifery Council. 13(4)(a)(b) The registered person must: 1. The seating that has DS0000005451.V282675.R01.S.doc 07/02/06 01/03/06 01/05/06 Avondale Nursing Home Version 5.1 Page 21 5 YA29 13(5) 6 YA30 13 cigarette burns in the red lounge are replaced 2. The corridor carpet outside the red lounge is replaced 3. Residents should have ample tables available to put drinks down. The registered manager must ensure that all residents using wheelchairs have received and assessment of their needs and use an appropriate chair Outstanding from previous report: previous timescale 01.01.06 The registered person must ensure that ‘notifiable incident forms’ must be completed and sent to the Commission for Social Care Inspection for any incident affecting the well being of residents. 01/04/06 01/03/06 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 Refer to Standard YA24 YA38 Good Practice Recommendations The manager may wish to look at the level of domestic cover currently employed at the home. 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.V282675.R01.S.doc Version 5.1 Page 22 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.V282675.R01.S.doc Version 5.1 Page 23 - 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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