CARE HOME ADULTS 18-65
Avondale Nursing Home Delphside Ltd 11 Sandstone Drive, Off Delph Lane Whiston Prescot Merseyside L35 7LS Lead Inspector
Miss Diane Sharrock Key Unannounced Inspection 6 /12th September 2007 10:00
th Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 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.V346299.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 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.V346299.R01.S.doc Version 5.2 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 4310330 0151 4300186 peterh@avondale.org.uk 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.V346299.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users to Include up to 50 (MD) Date of last inspection 27th June 2006 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. As the home has provided long stay placements for many residents it now has approximately 16 Residents who are over 65 years. 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 well-maintained garden area surrounding the home. The registered manager is Mr Peter Hamlett. The homes fees are from £693.94 to £788.99 per week. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over two days and was the homes key unannounced inspection. A selection of comment cards were sent to a sample of named Residents/ staff and further comment cards have been left at the home. Interviews and informal discussions took place with both Staff and residents during this visit. In total 6 Resident and 9 staff comment cards have been submitted to CSCI. Four of the resident cards had not been completed. The service was inspected against key standards for younger adults to see how well it was meeting a range of needs. These standards cover moving in, the care and support provided, daily routines and lifestyles, complaints, safety, comfort and cleanliness, how staff are employed and trained, and how the service is managed and developed. A tour of the premises took place and Resident care plans and various other records were inspected. “Case tracking’ was used as part of the visit to the home. This involves looking at the support and care a person gets when they live at the home and the quality of the staff that provide this. All areas of the inspection and findings were discussed with the Manager at the end of this visit. What the service does well:
The home provides residents with a large variety of activities to stimulate them. Annual holidays are arranged and offered to all residents. The home has well maintained gardens, which are accessible to residents. There is a large amount of day space with various communal areas and dining rooms. The dining rooms and tables are well presented. The general atmosphere is relaxed and sociable. The residents said the quality of the food is good. Residents at the home are included in a variety of decision-making. A regular residents forum is held where residents can make ideas and suggestions as to the running and development of the home. There were various positive comments from Residents and Staff about the home. The home continues to employ long-standing members of Staff who offer great stability to the home.
Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 6 There have been various initiatives including, audits and training to improve on the administration and storage of medications. This has led to Staff offering a more individualised approach to assisting Residents with their medications. Staff have continued with taking medicines to Residents own rooms or lounge/living area. What has improved since the last inspection?
All of the requirements made at the last inspection were met and showed improvements to the home and the company’s commitment in making Avondale a better place to live in. The company have implemented support to both staff and residents for those persons who want help in stopping smoking. They have arranged for staff to specialise in training in helping support people with stopping smoking. Some positive interactions were observed between Residents and Staff especially in the dining area and one of the lounges were residents were supported in being comfortable and choosing what they wanted to do. Staff stated they had worked at the home for many years, and discussed how they felt about it. They were very happy and settled and felt very proud of what they had achieved. They were happy with their training and felt they had benefited from all their courses. The training development plans for the home showed that training had taken place and included a wide range of courses to help Staff support residents diverse needs. The staff have developed and updated all staff files. They have produced evidence of all necessary checks being in place prior to Staff commencing employment at the home including CRB (police) checks. These files showed good recruitment procedures, which helps to safeguard residents at the home and shows good practice in supporting and training staff. Various other audits were also seen. Some covered health and safety, management of medications and care plans. These tools helped to show how well managed the home was and what checks were in place to maintain the standards achieved. The care plans have been recently developed and were easy to follow and concentrated on various areas including social skills and practical support in helping people with their mental health. The manager also plans to develop support with rehabilitation for some residents and has already developed rehabilitation plans that can be used to support people. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 7 Residents interviewed were aware of a complaints procedure and felt that if they had any concerns that they had would be listened to and taken seriously. One said ‘I can speak to the staff they can help me if I have any worries’ Those residents spoken with stated that staff were helpful and that they had no problems. The Registered Manager has been in post for many years and continues to provide an effective leadership role. Feedback from all parties stated how they were happy at the home and have confidence in the management of the home. What they could do better:
Full feedback was given to the Manager during and on conclusion of this inspection. There were various improvements noted especially in evidencing that outstanding regulations were now being met. However other areas were noted to need action taken and further evidence to be in place to meet other standards Some issues around choice were noted during this visit especially in some practices that did not reflect how the residents needs were being met. Continued poor practices must be stopped and quality checks on the care must be reviewed to make sure a good standard of care and support is given by all staff and at all times. Feedback must be given to residents so that appropriate support can be demonstrated in supporting all Residents in making choices. The manager agreed at the close of this inspector to look at all of these comments and would take appropriate action following this visit. The manager agreed to review access to infection control and food hygiene training; to make sure everyone was updated and knowledgeable about these necessary subjects. A company review should be carried out to ensure all staff are appropriately supported and well trained to meet the resident needs. The manager stated he would develop induction records to cover at least 6 to 12 months so that it was able to evidence all support and training given to meet the staff and residents needs. Supervision for all staff must be developed so that staff receive regular support in their various roles at the home. This was noted at the previous inspection. The home must have a complete file of essential policies, which are necessary to assist with good practice in updated procedures. The manager agreed to have the complete list of policies in place and accessible too staff as a matter of priority. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 8 The Statement of Purpose could be developed further to include details of the trial visits that are offered to any new prospective resident. Residents must be provided with any necessary equipment once they are admitted to the home. It is the companies responsibility to make sure one resident is supplied with a bed appropriate for them while they reside at Avondale. The manager agreed to have a new bed purchased as a matter of priority for this residents own comfort. Appropriate bedding and linen must be supplied to all resident’s. Poor standards of linen and towels must be removed, as it’s not respectful to residents living at the home. Further developments to the environment should continue to take place in developing younger adult facilities including the continual investment in refurbishment and the replacement of various floor covers in the home. Consideration should be taken into how each person’s bedroom facility could be developed to enhance their own private living space. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 9 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.V346299.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed before coming to stay at the home in order to ensure their needs can be met prior to their moving in to Avondale. EVIDENCE: Residents who are thinking of moving into the home are visited by the manager who completes an assessment. The resident is given a copy of the homes statement of purpose and service user guide which details what the home offers. This allows them to make an informed choice about the home. The home have displayed a Statement of Purpose on the notice board which gives residents details about the home. The manager gave detail of offering trial visits to any new residents. Discussion took place around these visits, as presently this example of good practice is not documented in any literature or statement of purpose. One pre assessment gave details about a residents needs and mental health problems, this record was used by staff to make a detailed plan of care for the resident. The Company do have assessment procedures and these show that an assessment of the persons needs are carried out with the person and care
Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 11 Manager prior to coming to stay at the home. This makes sure the Staff can meet the person’s needs. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6/7/9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are aware of residents choices and support them in decision making. EVIDENCE: Four care plans were case tracked and looked at. The company have developed all care records and have taken time to share and discuss these records with the residents. The new care records had also been discussed in the resident’s forum with resident’s opinions and thoughts taken on board. The manager explained that they try to aim for 3 monthly reviews of these plans. Some care plans had resident’s signatures and some residents had chosen to refuse to sign these records. This showed a good priority in maintaining up to date records and respecting the resident’s rights in choosing whether they wanted to be involved in their care planning. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 13 The company have taken a lot of effort to develop the care records so that they are clear in how they meet individual needs and are easy to understand. Pen pictures have been developed and offer background information about residents lives and offers further information in getting to know residents. Recent audits of care plans showed that they are regularly reviewed to ensure they maintain all the necessary information and standards needed to meet the residents care and support needs. One care plan had a road safety assessment in place highlighting all support necessary to keep the resident safe but also to develop and maintain their independence. Another care plan was able to give practical information around a persons needs who at times didn’t like to eat and another regarding their occasional auditory hallucinations, and another resident who was continuing to smoke in unsafe areas. Staff were able to give examples of how they communicate with all of the residents to find out what they want and do not want to do. Most staff had a good understanding of individual’s likes, dislikes and choices. The manager showed details of the availability of Advocacy service for residents which is independent of Avondale. Some residents choose to use this service and are supported in their choices and requests. The Manager plans to appoint two Care Co-ordinators to assist with the development of care planning and the introduction of quality assurance and the development of reahbitative support to residents at the home. This will help improve and develop the service further to meet the changing needs of residents at avondale. One resident made a request to be able to go out to a local shop so that she could independantly carry out her hobby with the assisstance from staff rather than relying on others to do this for her. This was discussed with the manager and agreed that the residents care plan should be developed to take account of this persons social needs and should give details of how her request will be supported. Some issues around choice were noted during this visit especially in some practices that did not reflect how the residents needs were wholly being met. One bed was noted to be too small for one resident recently admitted to the home. They did not have a lock for their bedroom door and were unable to have complete privacy to their own bedroom. They also agreed they would like their own facilities for storing and making drinks in their own home. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 14 The manager agreed to arrange the purchase of an appropriate and comfortable bed for this person and look at other facilities to make their stay more comfortable. One staff member was observed walking into a Residents bedroom without knocking on their door first. This was pointed out at the last inspection. Most other staff were observed knocking at doors before entering residents own bedroom. One resident was quietly sat in a bathroom and a member of staff was observed trying to give them advise but shouted across the room and resulted in the resident becoming agitated in how the situation was handled. Some bedroom doors were noted to be wedged open and highlighted a safety, privacy and dignity issue. When asking a staff member why the door was wedged open for 2 residents the member of staff stated they thought “its so the nurse can keep an eye on them.” The manager agreed that he needed to review all these issues with staff members and look at action regarding how staff are supervised in maintaining good practices and to take actions to stop all occasions of poor practices. Residents living at the home are invited to attend the resident’s forum; Residents use this forum to give ideas and suggestions as to the running of the home, activities and trips out. One resident now acts as a spokesperson at these meetings. The manager explained they are also looking at developing resident questionnaires to regularly gain their opinions about the home. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12/13/15/16/17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Staff support residents to access the local community and leisure facilities in accordance with their choices. EVIDENCE: The home have a structured activity plan which is displayed throughout the home and discussed as part of the residents forum. There are 4 activities staff responsible for organising the activities for residents. Activities take place both inside and outside the home and are supported by staff. One resident has joined a local college for a horticulture course and has also joined a local voluntary group. The august activity plan offered a variety of activities both 1 to 1 and group activities eg, Social mornings, charades, reminiscence, gardening, fishing trip, cocktail party, barn dance, cards, reminiscence, movement and dance, picnic by the
Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 16 pond, crafts, cinema, safari park, country drive, art, lunch out, coffee and games. Staff and residents have monthly ‘resident forum meetings’ to discuss the running of the home. Minutes of these meetings were seen and showed good discussions on everything at the home keeping everyone informed and included in the developments. Following a recent meeting and suggestions made the staff organised and introduced a fish and chip supper to residents, formed an angling group and had a recent trip to ten pin bowling. The residents minutes dated 26th July 07 covered trips out in great detail and showed that 6 residents went overnight to holiday in Blackpool, also one holiday is planned for North Wales and Yorkshire in September. Smoking cessation was offered to everyone and staff explained that 4 staff have had training to help people with stopping smoking if they wished. There were various positive comments from Residents and Staff who were all very enthusiastic about the home and the events on offer. Most interactions between Staff and Residents were observed as being very good and offering a good rapport. The manager explained that they were arranging for some of the residents to visit supported flats managed by “making space” and would support them to consider a move although he acknowledged some longstanding residents are not confident of wanting to move out of the home. The manager explained that their practices do not discriminate for any reason, everyone, be they resident or employee are treated in the same way and given the same opportunities and choice and they now have a policy for equity and diversity. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18/19/20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good understanding of residents support needs and personal care is provided in keeping with residents needs and choices. EVIDENCE: The developments of care plans have included more detail around the choices of Residents including the support needed and offered for personal care and were able to demonstrate they can meet the diverse needs of residents, including how the social needs and choices could be met. The care plans seen gave a good account of the resident’s needs and requests. Generally comments were very positive which was also stated in the resident comment card. Staff were able to explain the support they provide to each person. Residents were observed to be accessing various areas of the home independently of staff. Residents were also observed using their rooms and areas outside of the home independently. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 18 Residents have been offered the opportunity to have computer training provided and residents are supported with starting college courses and job’s locally in the community. Staff discussed the developments in auditing and administration practices regarding medication since the last inspection. Staff felt they had developed the administration of medications with the priority being to give residents a more personalised approach. Medication is stored in locked cabinets and trolleys are kept in a locked medical room. This was noted to be well organised with clear systems in place and records kept of stock checks and medication given. The administration and management of medicines are much improved with no identified issues during this visit. Medication audits had consistently taken place to ensure that appropriate standards are maintained. All records kept for the management of medications showed details of a safe and well-managed area. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22/23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies, procedures and practices are in place for dealing with complaints and aim to protect residents against abuse or neglect. EVIDENCE: The home have a complaints procedure that is accessible for residents which is time scaled appropriately. A copy of the complaints procedure is also available in the homes Statement of Purpose. Residents have their views listened to by staff and also via the resident forums. The pre inspection questionnaire gave details of complaints over the past 12 months and the homes complaints records were seen during this inspection. These records showed that any complaint made that staff had followed the company policy and dealt with it appropriately. Finance records were found to be very detailed and recent reviews have made sure that each residents personal allowance is transferred into their account on a weekly basis. During Staff interviews they explained they had attended mandatory training and were happy with the training on offer. Staff had received Abuse awareness training and had access to the homes policies. Staff are fully trained and experienced to support and protect residents.
Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 20 The manager explained that they hope to develop some training and awareness on abuse for any residents that may like to attend. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24/30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is generally well managed and provides a pleasant environment for residents. EVIDENCE: The homes pre inspection questionnaire gives details of all updated maintenance since the last inspection. Comment cards stated in their opinion the home was always clean and they were very happy with the facilities. There are various small lounges and a large games room provided in the home. There are also 2 attractively maintained dining rooms. The home is quite large all on one ground floor level and has various bathrooms and shower rooms. Some bedrooms were more personalised than others with lots of individual belongings in some. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 22 One corridor had various works of art and paintings displayed on the wall all created by residents living at the home. The home also has its own rehabilitation kitchen and laundry to help some residents with support of these life skills. Some areas in the home still needed further development as some had old worn staining and burns to floors, some had various storage and some bedrooms also had stains and burns to the flooring. This identified risks to people who continued to smoke in undesignated areas and it spoiled the presentation of the environment in these areas. One resident was noted to have a bed that was too small for them and they had no way of locking their room to keep their belongings private and accessible to just themselves. One resident felt they would benefit from a small fridge for their cold drinks and access to their own kettle so they could make drinks for them selves. This person was new to the home and regardless of them being satisfied with basic facilities more could have been done by staff to improve their bedroom facilities. One resident said they were sometimes cold at night. Samples of bedrooms seen were noted to have very thin duvets and no additional bedding or blankets in the resident’s rooms. The linen cupboard had a limited supply of blankets and a few thin duvets stored there. The standard of some linen provided to residents was noted to be shabby and frayed and not of good quality. The manager agreed to review these points with the Residents following this inspection and agreed to purchase a new bed that was more appropriate and to replace the current linen, bedding and towels. General discussions took place with Staff regarding further developments. Staff felt they were continuing with their role in developing the model to incorporate ideas to promote a more “homely” atmosphere and a less institutional approach to such a large living accommodation. A sample of maintenance certificates were seen and reflected accurate and up to date checks as listed in the homes pre inspection questionnaire. The home has health and safety practices and procedures, which are aimed at ensuring it is always safe and clean and free from hazards to the health and safety of residents/visitors and Staff. The kitchen area was very clean, tidy and very organised. The cook showed examples of how she encourages and reviews the personal likes and dislikes of each resident regarding their meals and always caters for any type of diet.
Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 23 The cook had also developed surveys for both staff and resident’s that she was hoping to implement by the end of the month. This will enable her to accommodate each person’s own diet and take into account any care needs they may have and offer individual choices with meals. An environmental health and safety audit was seen and had been carried out by the company’s own health and safety officers to show how areas had been improved and what areas were identified as needing development. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32/34/35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Residents are supported by a well-established Staff team who have been provided with training to support resident’s diverse needs. EVIDENCE: The home employs a large number of duel qualified nurses and support staff. There is always qualified nurse’s on duty 24 hours a day. Rotas at the home showed that there are enough staff to care for residents living at the home and that the turnover of staff is low. Staff personnel files were noted to be generally improved and those looked at were found to contain all relevant information and safety checks including police checks, induction, references and interview check lists. It was obvious that the home have good recruitment and selection procedures that help to safeguard residents. However just one issue recognised that one file did not show enough detail to support this staff member in meeting residents needs. This was also identified at the previous site visit and it was recognised that this persons training and development for caring and supporting residents had not been appropriate to
Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 25 safeguard residents. They had not received training on abuse awareness or other mandatory training. The manager stated he would develop induction records to cover at least 6 to 12 months so that it was able to evidence all support and training given to meet the staff and residents needs. Staff confirmed that they receive a variety of training and the pre inspection questionnaire gave details of all training that had taken place in the home since the last inspection. Training records gave no updated details for how many staff had received food hygiene and infection control training. The manager agreed to review this to make sure everyone was updated and knowledgeable about these necessary subjects. Staff came across as very enthusiastic and motivated and 2 staff said they felt the home was really good and everyone was responding in how to develop the home further to try and personalise the care offered and to develop rehabilitation in the home. In total 9 staff comment cards have been submitted, Some comments on the comment cards included, “Our managers go out of their way to support and help if need be to all members of staff.” One person felt the services does well in, “providing 24 hour nursing care, for the residents mental and physical well being.”. One person felt they had, “ a very good induction.” One person felt, “treats residents as individuals and treats them well.” One person explained what they have for communication at the home, including, “Regular meetings and handover, patient forum in place for residents to raise any issues or concerns.” Another person stated,” individual care on a holistic basis to meet the residents needs. Sufficient training for staff. Residents can attend sessions including fire lectures.” The manager explained that Clinical supervision is taking place for all trained nursing staff. Some staff were not receiving written supervision and some had not received the recommended amount of sessions per year. Staff are not always supported with supervision which is necessary to develop them and their jobs within the home. The Manager has a training plan, which is very organised and has details for various training that has been booked, including dates for forthcoming training. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 26 The investment in training for Staff has continued to help provide a mainly well-trained and competent team able to achieve appropriate standards of care and support and meet the diverse needs of residents. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37/39/42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, welfare and safety of residents and staff is promoted and protected. 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 a care qualification called NVQ level 4 in management and is supported by a team of other managers within the home. The Manager has been at the home for many years and offers a great stability and rapport to all the residents. The manager has given various details also contained within the homes pre inspection questionnaire that they have proposed to appoint 2 “care co coordinators” to support the Primary Nurse to ensure continuity of care. The Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 28 Care Co coordinators will then be responsible for the management of medicines and a model of support for rehabilitation for some of the residents. The Manager discussed various plans to look at the continuing development of the home for the future and benefit of the Residents needs. Health and safety is well managed and those records and health and safety company audits seen reflected a safe environment with appropriate checks in place. The Manager feels the home has moved on and developed for the benefit of the residents and that they would continue in looking at how they could individualise the service necessary for all of the residents needs. Discussion took place with the Manager regarding the improvements noticed during this site visit. General comments covered how the project could continue to develop so that it would eventually exceed the national minimum standards. Various other audits were also seen. Some covered care plans, which showed regular checks on the care records, medications, and health and safety checks. The home is visited on a regular basis by a representative of the organisation. In line with quality assurance processes the home is visited at least once per month and a report is produced with the findings of the visit. These visits form part of the quality assurance process and form an opinion on the standard of care provided. These management tools helped to keep everyone involved in the development of their home and show how their opinions can be included in future plans. The manager had developed a 12 point chart for the company objectives were clear and detailed actions have been planned stating how each point was to be measured over the next 12 months. This management and development tool had also been shared with staff and residents to ensure they were aware of the developments of the home. One pointer included ongoing developments and training in the administration of medication and to promote dignity and respect within the home. The manager had acknowledged in the homes pre inspection questionnaire that they did not have access to the complete list of basic polices. This included subjects such as, “moving and handling”, which are necessary to assist with good practice in updated procedures. The manager agreed to have the complete list of policies in place and accessible too everyone as soon as possible. Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 29 The Manager continues to organise regular Staff meetings. This ensures that Staff members have a regular forum to discuss issues that may affect the service provided to residents and the implementation of polices, procedures and practices within the home. Staff minutes were seen of recent Staff meetings. Some showed details of various topics about the home, including training and policies and procedures, the complaints policy, medication policies, Health and safety and staff training. Various risk assessments are kept in the Health and safety file including the fire risk assessment. A sample of maintenance certificates seen in the maintenance file, showed upto-date checks on facilities showing the home was well managed and kept safe and secure. The Company have various procedures in place to show how the home is being safely managed. Avondale Nursing Home DS0000005451.V346299.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 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 3 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 31 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 YA24 Regulation 16 2) c Requirement Timescale for action 09/11/07 2 YA37 24 1) 2) Residents must be provided with any necessary equipment once they are admitted to the home. It is the companies responsibility to make sure one resident is supplied with a bed appropriate for them while they reside at Avondale. The home must have a complete 09/11/07 file of essential policies, which are necessary to assist with good practice in updated procedures. 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 YA2 Good Practice Recommendations The Statement of Purpose could be developed further to include details of the trial visits that currently are verbally offered to any new prospective resident. The home should continue developing and creating a more homely environment for residents which is suitable to
DS0000005451.V346299.R01.S.doc Version 5.2 Page 32 2. YA24 Avondale Nursing Home younger adults. To provide all necessary facilities to enhance a persons independence and comfort eg kettles, lock to door, comfortable bed and bedding, personal fridges etc. further thought should be taken in looking at younger adults needs within their own living environment and look at what can be done to develop and extend these individual facilities. 3 4 YA32 YA32 Supervision for staff must be developed so that all staff receive regular support in their various roles at the home. To develop induction records to cover at least 6 to 12 months so that evidence is in place to support and train staff to meet the residents needs. To arrange for residents to be supported in their hobbies outside the home and update care plans to show how they will be supported. The home must ensure residents privacy and dignity are maintained at all times and stop ongoing staff practices of walking into bedrooms uninvited and leaving doors wedged open. Continued poor practices must be stopped and quality checks on the care must be reviewed to make sure a good standard of care and support is given by all staff and at all times. For the manager to review access to infection control and food hygiene training; to make sure everyone is updated and knowledgeable about these necessary subjects to maintain good practices within the home. 5 6 YA7 YA16 7 YA32 Avondale Nursing Home DS0000005451.V346299.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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