Inspection on 11/04/07 for Avondale Residential Care Home

This inspection was carried out on 11th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Avondale Residential Care Home 17/04/08

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Avondale Residential Care Home 106-108 Radstock Road Woolston Southampton Hampshire SO19 2HU Lead Inspector Tim Inkson Unannounced Inspection 11th April 2007 09:00 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 Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avondale Residential Care Home Address 106-108 Radstock Road Woolston Southampton Hampshire SO19 2HU 023 8044 5310 023 8044 5311 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) Society of St James Mrs Brenda Mary Lee Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15) of places Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users must be over the age of 62 years on admission. Date of last inspection N/a Brief Description of the Service: Avondale is owned by the Society of St James which is a Registered Social Landlord (Housing Association) and the organisation is regulated by the Housing Corporation. It has charitable status. It is a care home that provides care and assistance for up to 15 people over the age of 62 who need help because of frailty arising from either their age or a dementia related illness. The building comprises two semi-detached houses that were converted some years ago to create the one building. Some aspects of the two original dwellings remain such as two separate staircases in different sides of the home; one is fitted with a stair-lift providing easy access to accommodation on the first floor. The bedroom accommodation consists of 4 double/shared 7 single rooms, none of which have en-suite WCs. The communal areas include two lounge dining rooms and a quiet area, and externally a large rear garden with a patio and grassed area. Other facilities include assisted baths, the provision of full board and laundry. The home is located in a residential area within approximately a mile of a busy suburb of Southampton and all the amenities that could be expected in an urban area, including transport links. Potential residents are provided with a simple leaflet providing some information about the services that the home provides and they and/or their relatives are invited to visit the home. A notice board in the home informs interested parties of the availability of reports of inspections of the home carried out by the Commission for Social Care Inspection (“the Commission”). At the time of a key inspection of the home on 11th April 2007, the home’s fees were £385.21 a week, but this did not include, hairdressing, toiletries, private chiropody treatment, and newspapers and journals. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This fieldwork visit was unannounced and took place on 11th April 2007, starting at 09:30 and finishing at 16:50 hours. It was the first fieldwork visit to the home since ownership of the home changed in November 2006, as part of an inspection process in order to assess key standards that the home is expected to comply with. During the visit the accommodation was viewed, including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. Residents, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 12 residents and of these 5 were male and 17 were female and their ages ranged from 62 to 86 years. No resident was from a minority ethnic group. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. The “responsible individual” representing the organisation that owned the home was also available for some of the time. Other matters that influenced this report included a pre-inspection questionnaire with accompanying documentation completed and provided by the registered manager. The views of people living in the home were canvassed by the use of questionnaires and a small number of individuals (4) returned these before the fieldwork visit to the home was made. Information that the Commission for Social Care inspection received from the home such as statutory notices received about incidents/accidents that had occurred were also taken into consideration. What the service does well: What has improved since the last inspection? Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 6 This was the first key inspection of the home since new owners took over its management in November 2006. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 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 Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had procedures in place to identify the needs of potential residents before they moved into the home. EVIDENCE: A sample of the records of 4 people that were living in the home was examined including those concerned with the actions that the home took to identify the help and care that they needed. There was evidence from these documents that the admissions to the home of the individuals concerned had all been planned with staff with the appropriate knowledge and skills and that the process included visiting potential residents to identify the help and support that they needed before they moved into the home. A pre-admission assessment document used by the home was based on a ticklist and little detail about an individuals needs was included in the information recorded. Some important areas of peoples needs were also omitted. It was suggested that the pre-admission assessment document that the home used to identify the needs of potential residents be amended to include all those elements set out in standard 3.3 of the National Minimum Standards for Care Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 9 Homes for Older People. These include an individual’s oral health needs and if appropriate reference to a history of falls. There was also evidence that in some cases that the needs of some potential residents had been identified by staff working for the Adult Services Departments of local authorities under care management arrangements. The home had been provided with copies of these assessments of a person’s needs before the individual moved into the home. The home’s own pre-admission assessments were complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home. The home does not provide intermediate care. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans need to contain more detail about how the assistance that people require is to be provided and must be based on comprehensive assessments of needs including risks to an individual to ensure that their personal care needs can be fully met. The home must be able to demonstrate that individuals and or their advocates are involved in planning the care they receive. The home promoted the healthcare needs of people living in the home. Management of medication needs reviewing to ensure that it is managed more safely and effectively and that individuals’ rights are properly considered. Staff working practice helped to ensure that residents’ privacy and dignity was promoted. EVIDENCE: The care and plans were examined of the same sample of 4 residents as in the section above at page 9. In each case there was some basic information about some of the help, assistance and support that that the individual needed. One plan examined indicated that the person concerned could become agitated and daily notes kept by the home that complemented the plans of care indicated that there had been some occasions when the persons’ behaviour Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 11 had been challenging. These included reference to an incident when the home’s missing persons’ procedure had been implemented. There was no detailed information or guidance in the plan setting out the action staff needed to take when the person became agitated to ensure consistent management of difficult behaviour. Information in the persons record and discussion with the individual indicated that going out into the local community was important to them and their care included the following brief instruction: “Staff need to be alert when X goes out”. There was however no evidence of a comprehensive risk assessment having been completed about this aspect of the person’s daily life. However in all the other care plans examined there were risk assessments completed for very specific needs of the persons concerned such as, managing hot drinks by a particularly physically frail individual and the negotiation of the environment by an individual with a visual impairment. In care plans there were many general and brief instructions concerning the actions staff needed to take to provide the help that individuals required e.g. “Needs help with washing and dressing” More detailed instruction must be included to ensure individual needs can be met rather than assuming all staff understand what such brief statement means. The plans examined set out where relevant what specialist equipment was needed to provide the support and assistance each person required and this was observed to be available, provided or in place e.g. pressure relieving aid; Zimmer frame; or hoist. The licence/terms and conditions agreement issued to every person living in the home included the following statement: “Care plans will be drawn up in consultation with the resident and, where appropriate his/her relative(s) or advocate(s) enabling a clear statement to be made about what the resident can expect on a day to day basis and what the home should provide to meet his/her needs. Care plans will be reviewed on a regular basis to take account of change(s) in individual need”. There was no evidence from any of the care plans examined or from discussion with the individuals concerned or with some visiting relatives that either the person concerned or their relatives/advocates had been involved in drawing up and agreeing the contents of their plans of care. Records indicated that care plans were reviewed at least monthly. Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 12 residents about the abilities of staff the care and support that they provided included: • • • • • • • • • • “The staff are very good, if you want something you only have to ask” “I feel perfectly safe when they bath me”. “The staff are very good at what they do, they really go beyond the call of duty”. “Agency staff are very good, there is a young man and he is lovely and very kind” “The best thing about this place is the kindness and attitude of the staff. They look after you well. I have had two operations since I have been here and I lost a lot of weight but I have put it back on”. “The girls are alright, they help me”. “If we ring the emergency bells they attend our various needs” “The whole team at the home gave me a lot of support during my recent bereavement. No one could have asked for more”. “All the staff are kind and helpful”. Questionnaires returned to the Commission by people living in the home indicated that 75 felt that they always received the care and support that they needed and 25 usually did. All respondents indicated that staff listened to them and acted on what they said. The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Residents said that they saw and received treatment from among others, doctors, dentists, podiatrists and opticians and when required arrangements to attend outpatient clinics were made by the home. • • • “The chiropodist comes every 6 weeks”. “I have my eyes tested once a year and the optician comes to see me here”. “It is all arranged for us, chiropody and so on and they get in touch with a doctor if we need one”. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in a locked wooden cupboard, controlled drugs were stored another smaller lockable cabinet in the same cupboard. It was recommended that the home ascertained whether these facilities were compatible with the Misuse of Drugs (Safe Custody) Regulations 1973. At the time of the fieldwork visit to the home no controlled drugs were being prescribed for any one living there. Medicines requiring refrigeration were kept in separate locked containers in the home’s refrigerator. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 13 The home operated a monitored dosage system. A local pharmacist provided most prescribed medication every 7 days in blister packs for each person concerned. Other medicines that could not be put into blister packs because they could spoil, such as liquids or those that were to be taken only when required were dispensed from their original containers. There was evidence from staff training records and discussion that all care staff had received training in the management and administration of medication. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. The home strongly promoted the independence of residents and those residents assessed as being able and who wished to were encouraged to keep, and take their own medication. At the time of the fieldwork visit however no resident was managing his or her own medication. There was one matter identified during the fieldwork visit concerning medication that the registered manager was requested to review without delay with the appropriate health and social care professionals and any other interested parties. The medication of one person living in the home, who had some degree of dementia, was on the instructions of a doctor being crushed and put into diabetic medication. It was unclear whether this covert administration of medication was being done to: disguise an unpleasant taste; or because of swallowing difficulties; or because the individual wanted to refuse medication; and if it was the latter whether the rights and choices of the individual had been considered fully and in accordance with the procedures under the Mental Capacity Act 2005. During the fieldwork visit care staff were observed treating the people living in the home with respect and sensitivity. Individuals spoken with said that staff were polite and promoted their privacy. There were a number of double/shared bedrooms in the home and all of these were provided with screens. The screens were however latticed and the registered manager said that when they were used the staff put a sheet over them to provide effective privacy. It was apparent from discussion with some individuals that the screens were not routinely used and it is suggested that the registered provider/owner explores some alternative and more effective method of providing the essential privacy that should be provided in shared bedroom accommodation. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home were able to choose their life style and participate in a limited range of organised social activities that did not always meet their expectations They were able to maintain contact with families and friends. A healthy diet was provided by the home but there was no choice provided for the main meal of the day. EVIDENCE: Plans of care that were examined included details of the leisure interests of the individuals concerned and the home kept records of the activities pursued by persons living in the home both individual and as part of a group. Some of the preferences of individuals were recorded in their plans of care, such as the times they usually liked to get up and go to bed. Their preferences concerning food were kept in the home’s kitchen. One individual had apparently agreed to have access to and availability of cigarettes limited to prevent them all being smoked within a short time. There was however no written record of this agreement in the records of the person concerned. It was suggested that any such arrangement that could be perceived as an infringement of civil liberties and personal rights be properly recorded to ensure the protection of both the home’s staff and persons living there. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 15 There were some items in the home that could be used by the people living there to provide interest and stimulation e.g. playing cards, board games, large print books, DVD player, music centre and karaoke machine. Out of the 4 questionnaire completed by people living in the home and returned to the commission before the fieldwork visit took place, 1 indicated that, there were always activities arranged by the home in which they could participate, 2 indicated sometimes and 1 indicated never. Individuals spoken to generally indicated that there was little in the way of organised social events and activities that would provide stimulation apart from a singer that visited once a month and the occasional quiz that took place. At the time of the fieldwork visit there were no organised activities taking place. From conversation with people living in the home and visitors it was apparent that a number of individuals would like to go out on a coach trip. All indicated that routines in the home were flexible that they were able to pursue their beliefs and that visitors were welcome at any time. Comments about these matters included the following: • “It is very boring. I go for a walk each day ... I am a big reader and you will always see me with my head in a book … My son visits regularly and it depends on how busy he is ... The vicar comes sometimes, about once a month”. “I would like to go out on a coach trip in the summer”. “They could have occupational therapy”. “Visitors can come and go at any time they want”. “There are packs of cards if anyone wants to play. We had a game the other day”. “We can get up and go to bed when we want, we don’t have any restrictions at all”. “I can go out and the only thing I have to do is get up for meals, but that does not bother me. There are no restrictions here”. “Somebody comes once a month to sing. I would like to see more activities as he has not been outside for over 12 months. The vicar comes and gives him communion”. A singer comes once a month and she is very good and we all have a good singsong. I like doing criss cross puzzles. • • • • • • • • • A number of people that lived in the home were observed to be involved in individual activities that interested them such as reading, writing letters, and doing word search puzzles. During the afternoon of the fieldwork visit a number of people sat outside on garden furniture on the patio at the rear of the home conversing with one another and some of the staff that worked in the home. The atmosphere during the whole day was relaxed and friendly banter was observed taking place between staff and people living in the home. The responsible individual representing the organisation that owned the home indicated that efforts were being made to recruit volunteers to help with Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 16 organising activities. She also stressed that there was a project underway to improve the home’s garden to enable individuals with dementia to enjoy and get stimulation from it by developing a sensory area that would include raised flowerbeds and the introduction of aromatic plants. Some people living in the home had their financial affairs managed by relatives/advocates but some individuals looked after their own money despite the difficulties that could arise with such an arrangements such as rent arrears. One individual said, “My daughter does all my banking, I have nothing to do with it and don’t want to at my age. She gives me some pocket money”. All the people living in the home that were spoken to and those that retuned questionnaires to the Commission were complimentary about the food provided by the home and they confirmed that they had three meals a day and snacks and drink were available at other times. Comments about the food provided included the following: • • • • • “The food could not be better. The food is very good. There has only been one meal that I have not liked in all the time that I have been here. They ask you what you want in the evenings before you go to bed but not at lunch. We can have toast or something before we go to bed. “Breakfast could improve with bacon and eggs. Lunch is excellent and tea is fine” The menus and records of food provided indicated that the food was nutritious and there was a range of meals provided. In addition special diets and needs were catered for e.g. soft/ pureed meals and diabetics. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. The ingredients for pureed/soft meals were prepared separately. The menu indicated that there was only one main meal of the day and the cook indicated that there were no options or choices available for the main meal except for perhaps salads during the summer months. There was some discussion about how choices could be promoted and organised. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure to address the concerns of residents and relatives/representatives. Procedures concerned with safeguarding adults need to be strengthened to ensure that residents are properly protected from abuse and their rights are not compromised and that all staff working in the home are fully aware of them. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. Despite this some people living in the home were not aware of how to make a complaint but expressed confidence in being able to raise concerns with the home’s registered manager. • “I would be happy complaining to Brenda because she would sort it out”. The home kept records of complaints that included information about the issue, and set out details of any agreed action to remedy the matter as well as the outcome. There had been two complaints made to the home since its ownership had changed in November 2006, and they had both been responded to within the timescale set out in the home’s procedures and had been resolved. The Commission had received no complaints about the home during that time. The home had written procedures available concerned with “safeguarding vulnerable adults”. These were intended to provide guidance and ensure as far as reasonably possible that the risk of residents suffering harm was prevented. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 18 Some staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. Others indicated that they had not received the training but there was evidence that this was being addressed and relevant training was taking place during later in the month that the fieldwork visit took place. There was some discussion with the registered manager about the administration of crushed medication disguised in diabetic jam to one resident and also about another whose access to cigarettes was constrained (see also above in sections “Health and Personal care” and “Daily Life and Social Activities”). Both these practices could constitute abuse and infringements of individuals’ rights. In neither case was there evidence that comprehensive discussion and agreement about the appropriateness of the practice in the home had taken place between all the interested health and social cares professionals involved and with other representatives of the persons concerned. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s environment was reasonably well maintained and equipment and adaptations enabled people living in it to maintain their independence. There was an infection control policy and procedures in place and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: The home’s owner being a registered social landlord is regulated by the Housing Corporation that expects such organisations to implement procedures and to adhere to certain standards about the maintenance and upkeep of premises/buildings. The responsible individuals indicated that the home had a budget for planned and responsive maintenance and that all bedrooms were redecorated when they were vacated and also as with the rest of the building in accordance with a planned schedule. At the time of the fieldwork visit contractors were working in the home on decoration in the kitchen and an adjoining staff room. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 20 At the time of the visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were generally in reasonable repair with some exceptions. • The floor covering in the ground floor bathroom was badly marked in the immediate vicinity of the WC. • The paintwork/finish to the walls of the front lounge/dining room and quiet area was marked/pitted in places. The premises was provided and fitted with aides and equipment to ensure that the independence of individuals with disabilities was promoted. These included grab-rails and frames around WCs, railings to provide assistance and control when negotiating steps and hoists in bathrooms. All bedrooms doors had information on them to assist their occupants easily locate them. There was some discussion with the registered manager about appropriate decoration and furnishings for a home that provides a service for people with dementia. Such as colour contrasting doors to bathrooms and WCs and using plain floor coverings without busy patterns. The home had no written policy concerned with the sharing of bedroom accommodation and there were 4 double/shared rooms in the premises. The licence/terms and conditions agreement provided to all the people living there included the following statement: “In the case of rooms other than single rooms the provider reserves the right to introduce other residents to share the room”. The National Minimum Standards for Care Homes for Older People sate at standard 23.7: “Where a shared space becomes vacant, the remaining service user has the opportunity to choose not to share, by moving into a different room if necessary”. It is suggested that this standard be incorporated into the home’s policies and procedures or the licence agreement is amended to include it. The home had written procedures available concerned with infection control. It was noted that in accordance with best practice most communal WCs that were seen were provided with liquid soap dispensers (that were full but not all were working) and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. There was some discussion with the registered manager about the home’s procedures for cleaning commodes and she was referred to the new Department of Health document, “Infection Control in Care Homes” that can be downloaded from their website. The home was clean and generally odour free at the time of the fieldwork visit and people living there and visitors expressed positive views about these aspects including the condition of the accommodation generally. • • “The new owners are doing something with the garden”. “They are always doing something around the building”. DS0000068610.V331870.R01.S.doc Version 5.2 Page 21 Avondale Residential Care Home • • • • • “I have my own room. It is lovely” “I think that the condition of the building is fine. I have never seen it mucky”. “The cleaner hoovers during the day. The night staff clean the 2 lounges during the late evening when we are in bed”. “The cleanliness could not be better”. “I thought it was very nice even though she was only there for a month. My husband and I went to look at it. Ho looked into the cleanliness because he is fastidious. It did not smell”. The responses of all 4 of the people living in the home who returned questionnaire to the Commission sated that the home was always fresh and clean. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was an appropriate and satisfactory level and mix of staff in the home that ensured the needs of people living there were met. The home had clear staff recruitment, training and development procedures that were not fully adhered to and consequently failed to ensure that people living there were properly protected and supported. EVIDENCE: The staff team working in the home comprised, 8 care staff, one domestic, one cook and the registered manager. Out of the former 5 (i.e. 63 ) had obtained a qualification equivalent to at least National Vocational Qualification (NVQ) at level 2. The registered manager said that a further 2 were working towards the qualification. At the time of the fieldwork visit the care staff rota setting out the minimum number deployed in the home at any time was as follows: 08:00 to 14:00 2 14:00 to 21:00 2 21:00 to 08:00 2 wakeful The registered manager said that in addition she worked for 5 days a week between 07:00 and 17:00 hours. The organisation that owned the home was able to provide support and assistance with staff recruitment through its human resources department, as Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 23 well as financial advice and maintenance of the premises. The homes registered manager reported to the organisations responsible individual. Comments from people living in the home and relatives about the sufficiency of staff include the following: • • “There are always 2 staff on duty when I come and if it is the 2 who are on today they are lovely”. The staff were pleasant and the food was excellent and we were quite impressed. Brenda (the registered manager) is very pleasant and staff were lovely with residents, if they soiled themselves they were there quickly with a change of clothing. All the residents were well kept and smartly dressed “Sometimes there are enough and sometimes there aren’t”. • See also the comments about staff in the section above about “Health and Personal Care”. Staff spoken to during the fieldwork visit said: • “Two is enough, although sometimes when someone is unwell you could do with a third. But then most of the residents are able bodied”. The organisation that owned the home had a written policy and procedures in place concerned with “selection and recruitment of staff”. The record was examined of one member of staff that had been employed to work in the home since the new owner/registered provider took over the home in November 2006. It was apparent that the person had started work before all the necessary per-employment checks had been completed. As she had started work on 19th March 2007 and a satisfactory Protection of Vulnerable Adults check was not received until 26th March. There was no documentary evidence of this at the home because recruitment was organised through the human resources department of the organisation that had owned the home since November 2006. The registered manager notified her colleagues at the head office of the need to provide some documentary evidence of receipt of satisfactory Criminal Records Bureau (CRB) disclosure. At the time of the fieldwork visit the person referred to above was working under strict supervision and had no unsupervised access to people living in the home. The registered manager was reminded of the expectation set out in the Department of Heath document, “Protection of Vulnerable Adults Scheme” (16/05/2006). It states that only in very exceptional circumstances may a person be employed in care positions without waiting for the full results of a CRB disclosure. In order to do so they must have applied for and received a satisfactory POVAfirst check (page 13 at paragraph 38). Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 24 The new member of staff was receiving in-house induction training and arrangements had been made for her to attend a training centre managed by a local voluntary organisation and social care service provider to complete a formal induction training programme that would satisfy the standards of “Skills for Care” the social care workforce development body. The organisation that owned the home had a staff training policy. It was apparent from discussions with staff, the registered manager and the responsible individual representing the organisation that staff training was a priority and a lot of staff training had already been provided and was being arranged. Staff training records indicated that a lot of staff had already completed and attended training courses for recognised, appropriate formal qualifications i.e. National Vocational Qualification and also in subjects that were relevant to the needs of residents in the home such as: Stoma care; challenging behaviour; diabetes and insulin management; dementia and mental health; care of the skin; continence promotion; supervision; infection control; abuse/adult protection; MRSA; scabies; equality and diversity; and complaints. The registered manager said that training planned for the immediate future included; health and safety; mental health; boundaries; substance misuse; and abuse. Staff spoken to were appreciative of the opportunities that they had to enhance their skills and knowledge. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Leadership of the home was weak in some areas. The home was unable to demonstrate that people living there were fully able to influence the quality of the service that they received. There were robust systems and procedures in place for supporting staff and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The registered manager had been in post for 5 years and she had completed the Registered Managers Award in 2003. Prior to being employed as the manager she had progressed from carer to senior carer in the same home and had worked there since 1992. Comments from people living in the home and some relatives/visitors about the registered manager’s qualities and abilities included: • “Brenda is very efficient with the staff. I find her alright”. DS0000068610.V331870.R01.S.doc Version 5.2 Page 26 Avondale Residential Care Home • “ Brenda is very pleasant”. The home’s staff that were interviewed in order to ascertain the manger’s approach to running the home and they described her as “OK”. It was apparent from matters that have already been referred to above in the sections about “Health and Personal Care” and “Daily Life and Social Activities” and “Complaints and Protection”, that the registered manager was; unclear about her role as an advocate for some of the people living in the home or able to demonstrate that all their rights were promoted; had not fully considered how choice could be extended/enhanced with matters such as the main meal of the day and activities; and had not fully implemented a quality monitoring system in the home (see below). Questionnaires had been used by to home to obtain the views of the people living there but the manager was unable to demonstrate that the information obtained had been collated and used to inform any decisions about the service that was provided. There was no evidence that regular meetings were arranged for the people living in the home at which they could comment about aspects of life there that were important to them. This should improve as the organisation that owned the home was also regulated by the Housing Corporation and it requires such organisations to promote tenant participation. There were a range of written policies and procedures available that helped to inform working practices in the home and some were clearly “old”, while others had been developed by the organisation that had owned the home since November 2006. They included among others the following: • • • • • • • • • User involvement Visitors Equality and diversity Recruitment and selection of staff Whistle blowing Abuse Complaints Training Supervision It was apparent from an examination of staff records that the organisations policy about staff supervision was being implemented in the home. Regular one to one supervision and support sessions were being provided for the home’s staff and that the manager was also benefiting from regular meetings with her line manager. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 27 Most of the people living in the home had their financial affairs managed by relatives or representatives. The home looked after small sums of money for some individuals that had been left with or handed over by relatives or representatives. A sample of records of monies held on behalf of residents was checked and they were accurate and up to date. Information provided to the Commission before the fieldwork visit took place indicated that some of the homes systems and equipment had been serviced and checked to ensure that they were working safely i.e. Gas central heating; hoists and stair lift. There was however no documentary evidence in the home to support this. There was some discussion with an assistant financial controller at the head office of the organisation that owned the home who was able to confirm that the documents were held there as well as a copy of a fie risk assessment of the home and a current certificate of Employers Liability Insurance. He said that he would arrange for copies to be made available to be kept in the home. The home’s fire logbook was examined and it indicated that fire safety equipment was tested and serviced and staff fire safety training was done at regular and appropriate intervals. There was evidence that a monthly health and safety audit of the home done. Any matter requiring attention was identified and subsequently plans with a timescale for completion of any work required were recorded. Guards covered all radiators in the home and there were hoists, and other equipment in the home to promote safe working practices. Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 28 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 12 & 15 Requirement Care plans must describe in detail the actions staff must take to provide the help and support that people living in the home need including how to manage difficult behaviour. This is to ensure that staff practice is consistent. Evidence must be available to demonstrate that people living in the home or their representatives have been involved in developing and agreeing their care plans. This is to show that individuals needs, wishes, preferences and any limitations of their rights as far as is reasonably possible been agreed with them. New staff must in future not work in the home until all the necessary per-employment checks have been completed. This is to ensure that a person who is unsuitable to work with vulnerable adults is not employed in the home. Evidence must be available that the views of people living in the DS0000068610.V331870.R01.S.doc Timescale for action 31/07/07 2 OP7 15 31/07/07 3 OP29 19 30/04/07 4 OP33 24 31/07/07 Avondale Residential Care Home Version 5.2 Page 30 home about the quality of the service the home provides have been taken into account and where reasonable and appropriate acted on. This is to ensure that the home is run in the interests of the people living there. 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 OP9 Good Practice Recommendations Appropriate professional advice should be obtained to ascertain whether the home’s storage facility for controlled drugs complies with the Misuse of Drugs (safe Custody) Regulations 1973. Consideration should be given to providing better screening in shared bedrooms. This is to ensure that privacy may be promoted more effectively. People living in the home should be offered a choice for the main meal of the day. This is to ensure that individual preferences can be met. 2 3 OP10 OP15 Avondale Residential Care Home DS0000068610.V331870.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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