Inspection on 17/04/08 for Avondale Residential Care Home

This inspection was carried out on 17th April 2008.

CSCI found this care home to be providing an Adequate service.

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 11/04/07

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 Neil Kingman Unannounced Inspection 17 April 2008 09:45 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.V361279.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.V361279.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.V361279.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 11 April 2007 Brief Description of the Service: Avondale is a residential care home providing care and accommodation 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 home is managed by Mrs Brenda Lee on behalf of the proprietors The Society of St James, a Registered Social Landlord (Housing Association) with charitable status The building comprises two semi-detached houses that were converted some years ago to create the one building. There are 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. Accommodation comprises four shared and seven single rooms, none of which has an en-suite WC. 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 and 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. At the time of our inspection the home’s fees ranged between £340. 62 and £401. 94 a week, but this did not include, hairdressing, toiletries, private chiropody treatment, and newspapers and journals. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by Avondale and brings together accumulated evidence of activity in the home since it was last inspected on 11 April 2007. Part of the process has been to consult with people who use the service. To this end we have received seven written responses to a survey of people who live in the home. Included in this inspection was an unannounced site visit to the home by an inspector on 17 April 2008. The registered manager Mrs Lee and the Responsible individual for the Society Ms Smith were available throughout the day. At the visit we had an opportunity to speak with the staff on duty, the residents and several visitors. We also toured the building and looked at a selection of records. Prior to the site visit the manager sent to the Commission a detailed selection of information about the service including an Annual Quality Assurance Assessment (referred to as ‘the assessment’ during the report), which has been used with other information to inform the various judgements made about the service. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: In a general sense the home promotes independence with flexible routines. People can exercise choices and come and go as they please. However, responsive help from a committed staff group is on hand. The food provided is well cooked and presented, and people are very satisfied with it. The cook has a good understanding of peoples’ likes and dislikes. There is a low turnover of staff and an improved programme of staff training and development, which ensures staff have the skills and experience to meet peoples’ changing needs. Staff showed a commitment to providing a good service for people. Visitors are made very welcome and there are no restrictions. On the day of the site visit relatives and friends were visiting throughout the day. It was very clear that they have a good relationship with the home, which was reflected in comments they made to us. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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.V361279.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.V361279.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. EVIDENCE: People should know that their needs will be met when they move into a home. An important part of ensuring this happens is the pre-admission assessment process. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 9 The manager described the home’s admissions process in general, and specifically in relation to the newest person to be admitted: Typically the manager would visit the person who may want to use the service either at their home address or other place where applicable. An assessment of care needs would take place at that point, using the Society’s assessment tool. The home always prefers the individual and/or their representative to come in for pre-admission visits wherever possible. One of the most recently admitted people moved in to Avondale from another service run by the Society in December 2007. The manager carried out a preadmission assessment having first obtained an assessment from the Social Services Care Management. A copy of the initial admission assessment was available on this person’s file. Following advice given at the last key inspection of the home a new improved assessment is being used, which now meets the Nation Minimum Standard. Assessments were also noted on other care files looked at during our visit. The manager showed a good understanding of the importance of a thorough pre-admission assessment in the process of choosing the right home. People who live at Avondale tend to be long term. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. However, respite care is provided if there is a room available. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • We make all prospective residents and their relatives feel very welcome and they are invited to visit the home several times before they make their decision. All information provided about the service is clear and easy to understand and all prospective residents are guided through the assessment process that we use for establishing whether the level of care they need can be provided. The care home offers respite care and is able to ensure that the care needs of the individual are met in the same way as they are met in their usual place of residence. In the last 12 months we have made our assessment procedures more robust. • • Avondale Residential Care Home DS0000068610.V361279.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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. However, assessments need to be carried out to minimise risks that are identified. The principles of respect, dignity and privacy while generally put into practice could be improved with suitable screening in shared rooms. EVIDENCE: The home has a system of care planning with an individual personal plan for each resident. We looked at a sample of three plans. The intention was to look at the outcomes for people who use the service in general by assessing all areas of care for those sampled. The sample included a long-standing person with illness associated with dementia, a person with alcohol dependence who presented with challenging behaviour, and one of the newest admissions to the home. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 11 Plans identify peoples’ abilities and problems. They set out the aims of care and the method to be used. Some risk assessments are in place and the manager said that they had been improved since the last inspection by introducing the Society’s risk assessment format. However, while plans and risk assessments contained basic information they could be improved by recording more detail in a person centred way; an example being under the heading ‘method’, where the information is brief, e.g., “no problems” and “daily support”. The home uses a care planning model developed and supplied by a company. It was noted that elements of the plans are clinical and do not support staff to provide the help and support that people need, and or, want. We had a discussion with the manager who recognised that plans could be improved by taking a person centred approach to all areas so that they become personal to the individual concerned. During our discussions with staff and the manager it was identified that the behaviour problems experienced with one individual had a negative impact on another resident. There was no risk assessment in place to cover this specific situation and, as outlined later in the report Safeguarding Adults procedures had not been implemented effectively. There were also concerns about other aspects of this individual’s behaviour, which raised the question as to whether the home could meet this person’s needs effectively. In discussions with the manager and the Responsible Individual it was understood that arrangements were in place to recruit an experienced person with specialist skills to the staff team and the issues identified were being addressed by the home in liaison with social services. Issues around this individual’s admission to the home are being addressed through separate correspondence with the Society. Since the last inspection arrangements have been made for residents or their representatives to sign their individual care plans to demonstrate that they have agreed their plans and been involved in their development. There were mixed views about care plans when we spoke to the residents, which is understandable where some people have dementia. They ranged from individuals who showed little interest and understanding about them to one person who was fully involved in their plan, which involved a written contract, signed and agreed by the individual concerned. The manager confirmed, and records evidenced the regular contact with GPs, optician, dentist, chiropodist and mental health specialists. Records showed and discussions with the manager and care staff confirmed that the risk of pressure sores was currently low. The manager said that staff are always vigilant and the care they took when they managed continence and pressure areas meant problems were kept to a minimum. Liaison with the Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 12 Community Nurse was good. Staff spoken with were very clear about what was required to ensure that pressure sores did not develop, i.e., suitable equipment, good liaison with the Community Nurse and care practices. The manager said, that people are able to continue with their GP and dentist of choice if they happen to be local. However, with four GP practices in the area there is no problem with lack of choice. The manager said they were currently experiencing difficulties with access to a dentist. Other healthcare professionals including the more specialist ones e.g., Community Psychiatric Team are called upon as and when required. We noted a good deal of involvement with specialist healthcare professionals for the person who presented with challenging behaviour. Six responses to the service users survey indicated they always receive the care and medical support they need and one indicated usually. Medication is given to the residents by means of a cartridge system, known as the Nomad system, which has separate compartments for regular times throughout the week. This hygienic method is designed to simplify the procedure for giving out medication. The manager said only staff who have completed the safe handling of medication training and are competent are permitted to give out medication. The home has a policy and system to ensure residents’ medication is stored, administered and recorded safely. During the site visit we looked at the arrangements in place and noted medicines were stored under secure conditions in a locked metal cabinet, which had been introduced following a recommendation at the last inspection. Accurate records of receipt, administration and disposal of medicines were being maintained. The importance of treating people who use the service with dignity and respect is covered in the induction training for new staff. On the day of the site visit we toured the building and spent time with residents in the communal areas. There were opportunities to observe staff at work. Staff spoke kindly to people and addressed them by the name they preferred. We noted during the tour of the building that the manager knocked on doors and waited for an answer before entering a room. All residents have locks on their room doors and can come and go as they please. Lack of suitable screening in shared rooms is dealt with later in the report. There were many signs of well being amongst the residents in the communal areas. In discussions with individual residents and visitors it was very clear that staff treat people kindly and respect their privacy. Residents can use the facility of the home’s portable telephone to make and receive calls, in private if they wish. We saw this in evidence during our visit Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 13 where a resident felt very confident about using the telephone to receive a private call. The home will arrange for private installations in bedrooms on request. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • Each resident has an individual care plan that meets their needs. These care plans are reviewed on a regular basis, in consultation with the residents and with their relatives. All residents are treated with respect and staff ensure their personal dignity is always upheld. Avondale Residential Care Home DS0000068610.V361279.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle and activities are offered to suit their individual needs and expectations. Friends and family are made to feel welcome and can visit at any time. Residents’ nutritional needs are satisfied with a varied and balanced diet of good quality food. EVIDENCE: The home’s assessment shows and the manager confirmed that residents are encouraged and supported to exercise choice and control in their lives according to their abilities. Routines for residents are kept as flexible as possible, e.g., they have choice over where and when they have their food served, what time they like to be woken and the time they like to retire, where and when they like their breakfast served etc. This was confirmed in discussions with the people we spoke with. The exercise of choice was particularly relevant to one individual who was seen to eat in one of the dining areas but separate to every one else. This individual was very clear that it was their choice to be alone. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 15 The home has a weekly programme of in-house activities, such as bingo, arts and crafts and a visiting musician. Of the seven responses to the service users survey there were mixed messages about activities. Three indicated there are always activities they can take part, two indicated usually and two sometimes. One commented, “We are never taken out, those that are capable of going out. There is not much that goes on in the home, except watching television.” Another commented, “We could do with short walks for exercise and trips out in a minibus.” We spoke with residents and visitors about the activities in the home. Several said they would enjoy being able to go out and special mention was made of the state of the rear garden, which appeared uninviting with one of the dividing fences down, overgrown grass and inadequate seating. On the positive side both the Responsible Individual and the manager confirmed that they had carried out a survey and had already responded to the views of the residents and funding was now available to greatly improve the facilities in the garden with a sensory area, new pathways, fencing, seating and a water feature. In addition, an interactive music workshop was due to commence the following day. They were planning trips out once a month in a minibus to places of entertainment and interest, picnics and also barbeques in the summer. Details of visiting arrangements can be found in the service user’s guide, which is currently in the process of being updated to provide an information booklet with information displayed in a more ‘user friendly’ format. Visits are generally unrestricted and family and friends are encouraged to visit. This was very much in evidence on the day of our visit with opportunities to speak with families in the communal areas. People can receive visitors in their own rooms or any of the communal areas. All visitors spoken with said they were always made welcome by staff and offered some refreshment when they arrived. Residents were spoken with individually in various parts of the home and in a group over lunch. Those who were able to express views said they were given choices regarding routines in the home, e.g., times of rising, going to bed, activities, meals, personal care, going out etc. The visitors we spoke with supported this view. The manager confirmed that all but three residents have someone independent of the home to support them. Family are able to assist people with their financial affairs and three residents are able to control their own monies. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 16 People are encouraged to bring with them pictures, ornaments and personal items for their room. During the tour of the building it was noted that a number of rooms were very well personalised, others less so, according to peoples’ individual tastes and preferences. The management of residents’ finances is covered later in the report but in a general sense they are encouraged, with support from family or a representative, to handle their own financial affairs for as long as they are able. Menus are arranged on a four-week rota and those seen showed that food is generally varied, nutritious and appealing. The home employs a cook who has been at Avondale for many years and is very familiar with peoples’ likes and dislikes. Special diets and needs are catered for. We had an opportunity to sit with some of the residents over lunch. The atmosphere in that part of the dining room was quite sociable and friendly. Other residents ate together in another dining area and one person ate alone. Staff were attentive throughout lunch and the banter was warm and friendly. The whole experience was relaxed and unhurried. In discussions about the food on offer residents generally agreed that it was always a good standard. While there is just one main meal at lunchtime alternatives are always available. We noted one resident gave their own suggestion for an alternative, which was no trouble to produce. Food served on the day of our unannounced visit was in line with the menu for the day and included fresh meat and a variety of vegetables. It was well presented and well received by all those who gave a view. The home provides drinks and light snacks throughout the day. Six of the seven responses to the survey indicated they always like the meals in the home and one indicated usually. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • • All residents are encouraged to be social and most residents eat their meals together. Residents with particular cultural or religious beliefs have their dietary needs met. Residents participate in reviewing menus and new dishes have been introduced as a result. Tea, coffee and other drinks are always available. There is a TV lounge and residents are encouraged to participate in other social activities such as bingo and quizzes. DS0000068610.V361279.R01.S.doc Version 5.2 Page 17 Avondale Residential Care Home 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home treats residents’ complaints seriously and responds appropriately. The home’s policies, procedures and practices could be improved to ensure that residents are safeguarded from abuse, by ensuring that incidents involving the abuse of vulnerable people are reported to the relevant authorities. EVIDENCE: The home has a complaints policy and procedure, details of which can be found in the statement of purpose, which is available to all residents or their representatives. The procedure for making a complaint is also prominently displayed in the hall. However, it needs to be updated with the current contact details for the Commission for Social Care Inspection. The Responsible Individual confirmed that this would be done as they were in the process of developing new documentation and would soon be publishing a resident’s charter, giving details of peoples’ rights, entitlements and expectations. Information provided by the home prior to the inspection shows there had been one complaint since the last inspection. The manager said that the record of the action taken in respect of complaints is kept centrally with the Society. It is important that a copy is also made available for inspection in the Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 18 home. This is to demonstrate that peoples’ complaints are treated seriously and dealt with correctly. The Responsible Individual agreed to arrange it. People spoken with on the day of the site visit were not familiar with the detail of the complaints procedure, but were very confident about raising any concerns with the manager. Five responses to the survey indicated residents knew how to make a complaint and two did not. All indicated staff listen and act on what they say. The Society of St James has introduced its own Safeguarding Adults policy and procedure, which follows local authority guidance. However, The Responsible Individual confirmed that they were in the process of producing a policy and procedure that was individual to Avondale. This is important, as clear and specific guidance on reporting procedures is needed. As mentioned earlier in the report we noted that an incident involving a safeguarding issue with one of the residents had taken place and had not been referred to either Social Services or the Commission. In discussions with staff we were told that while safeguarding adults training is provided they were unable to attend a session scheduled for later in the week due to staff shortages. We discussed this with the manager and Responsible Individual who confirmed that the training was being scheduled for the following month. The staff members spoken with showed an understanding of how to recognise abuse and were very clear about the importance of reporting issues of concern without delay. They also were aware of the home’s “ whistle-blowing” procedures. It must also be said that adult protection is a subject covered in the National Vocational Qualification (NVQ) training programme, which over 60 of staff have completed. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • • We operate a clear and robust complaints policy, which all residents and their relatives are shown at the start of their residency. All complaints are taken seriously and the Registered Manager keeps all parties to the complaint fully updated and informed throughout the investigation process. All investigations are carried out discreetly and confidentially and all staff are trained in the procedures that must be followed in the event of a complaint being raised. Al staff are subject to CRB and POVA checks; all new staff undergo induction training that deals with all policies and procedures that the care home operates under. We have improved access to training for staff on policies and procedures. DS0000068610.V361279.R01.S.doc Version 5.2 Page 19 Avondale Residential Care Home 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, 24 and 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. Most but not all areas of the home are kept clean, hygienic and free from unpleasant odours. EVIDENCE: Avondale Residential Care Home has been a home for older people in Southampton for many years and underwent a change in registration in November 2006 when the Society of St James became the new owners. While not purpose built the home has been developed and adapted over the years to be suitable for its stated purpose of providing a safe, manageable and comfortable environment for the people who live there. The home is located in Radstock Road, within a mile of the shops and amenities of Woolston, Southampton. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 20 The Society of St James 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. It was evident during our tour of the building that since the last inspection an ongoing programme of decoration and maintenance has been effective in improving the standard of the environment. New carpets, furniture and decorations give rooms a fresh and modern feel. However, on arrival at the home we noted a collection of leaves had accumulated just inside the front porch. Given the time of year it could be assumed they had been there for some time. Several cobwebs were evident above the door. We discussed this with the manager and Responsible Individual who confirmed that the amount of work having been done inside the home meant that attention to this area had slipped. All areas of the building are accessible to the people who use the service, including the rear garden, which as mentioned earlier in the report is the subject of an improvement plan, as funds are now available to develop it. The home is generally comfortable, well furnished and decorated. Communal areas are well decorated and furnished. We toured the building with the manager and Responsible Individual. Bedrooms are well decorated and furnished and have a homely feel about them. With the exception of one room bed linen was noticeably crisp and clean. Four of the rooms are shared and contain wooden wicker screens, which are transparent. This had been an issue identified at the last inspection, as it does not ensure privacy for personal care. The manager said that staff place a sheet over the screen if privacy is required. In discussions it was agreed that this was not acceptable. It did not promote peoples’ dignity or independence, as they would be relying on staff to assist them every time they wished to use the washbasin. People who live in the home have rooms on the ground and first floors. There is a stair lift, which affords access to all rooms on the first floor. Assisted bathing and toilet facilities on both levels are adequate for the needs of people who use the service. However, the manager confirmed that people tended to use the assisted bathing facilities on the ground floor. There is a bathroom on the first floor, equipped with a hoist, which tracks from the ceiling. The manager said that due to its’ design it was not popular as people did not feel safe using it. People spoken with were generally satisfied with their rooms and the standard of the environment in general. One person made special mention of being able to have their furniture and possessions around them. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 21 All areas of the home were found to be very clean and free from unpleasant odours, with the exception of one person’s bedroom, which was noted to be well below the standard maintained in all other rooms in terms of cleanliness, tidiness and odours. A discussion was held with the manager and Responsible Individual about the home’s ability to meet this person’s needs. As mentioned later in the report the home employs domestic staff to ensure the standard of hygiene is maintained. Although staff spoken with expressed concerns over the difficulties experienced with managing issues in relation to the personal hygiene for one individual. There is a laundry sited in the rear garden, a few steps from the building. It is equipped with commercial grade machines capable of washing articles at the right temperatures. The home’s assessment confirms it has policies and procedures for preventing infection, managing infection control and soiled waste disposal. During the tour of the building it was noted that all bathrooms and WCs were equipped with liquid soap and disposable towels. Six of the seven survey responses indicated the home was always fresh and clean and one indicated usually. A comment in one of them was, “The home is very clean but it does need updating. Perhaps a conservatory so that residents can look out into the garden.” Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • The internal decoration and presentation of the care home is maintained to a high standard. Cleanliness of the home and all the facilities is of a very high standard. All communal areas of the home are accessible to the residents, and there are facilities in place that provide extra assistance for residents with mobility problems and impaired sight. Internal decoration of some rooms has provided more hygienic facilities for the use of commodes in the bedrooms, and has improved general hygienic standards. Avondale Residential Care Home DS0000068610.V361279.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are deployed in sufficient numbers, are trained and given the necessary skills and experience to meet the needs of the people who live there and support the smooth running of the service. EVIDENCE: The home employs eight care staff. There are two main shifts throughout the day when a minimum of two care staff are on duty at all times. The home employs additional catering and domestic staff. Overnight there are two waking night staff. The manager works in the home each day in addition to the care team. In discussions on the day of the site visit there were no concerns raised by residents or visitors about staffing levels. In discussions with the care staff they made the point that currently there were only eleven residents accommodated and the present levels were sufficient to meet their needs. However, they highlighted problems with flexibility, i.e., cover at times of sickness and holidays. The cancellation of the safeguarding training is a good example of the problems currently being experienced. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 23 Three of the seven survey responses indicated there are always staff available when they need them and four indicated usually. Records showed and the manager confirmed that currently five of the eight care staff have achieved the National Vocational Qualification (NVQ) at level 2 (63 ) with two currently undertaking the training. The home’s NVQ training programme ensures the standard of 50 qualified staff is maintained. At the last inspection a requirement was made that new staff must not work in the home until all the necessary pre-employment checks have been completed, and specifically Protection of Vulnerable Adults (POVA) checks. The home has now met that requirement. Individual staff recruitment files were available for inspection. Two new staff had been recruited since the last inspection, although one had left prior to our visit. An audit was carried out on both recruitment files. Two written references and Criminal Record and Protection of Vulnerable Adults (POVA) checks are now carried out on all staff before they commence working in the home. In discussions with the manager it was confirmed that evidence of a person’s physical and mental fitness to work in the home would be called for, or if it is impractical a declaration signed by the individual that they are fit. Since the Society of St James took over the ownership of the home it has introduced an induction programme for new staff, which now follows the Common Induction Standards required by ‘Skills for Care’. The manager said that the programme is in place but not yet implemented. However, new staff will be inducted into the new programme and it is the intention of the Society that all existing staff in the home have an opportunity to experience it. Staff training is ongoing. The Responsible Individual explained that the Society has introduced a new training strategy, which identifies staff training needs through supervisions and appraisals to ensure that training is kept up to date. There was evidence that refresher training in mandatory subjects had been scheduled. Staff spoken with confirmed that training in mandatory subjects was being arranged. Staff training includes: Manual handling Food hygiene First aid Health and safety Dementia awareness Safeguarding adults Medication Fire safety Infection control Managing challenging behaviour Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 24 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. However, attention needs to be paid to the development of risk assessments to ensure that the correct measures are taken to minimise risks to people who use the service. EVIDENCE: The registered manager Mrs Lee has managed the home for the past six years and has achieved the Registered Managers Award (RMA) and NVQ at level 4 in care. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 25 In addition, she states that she updates her knowledge, skills and competence with periodic training in care related subjects specific to the service provided by the home. In discussions with the manager it was recognised that an area for improvement is the rerecording and reporting of safeguarding issues. Staff spoken with during the site visit confirmed that formal supervision sessions were taking place. However, staff meetings were not so regular, the last one being in September 2007. They felt the manager was approachable and supportive and staff morale was OK. One area that was raised as a concern and discussed with the staff, the manager and the Responsible Individual was a perceived change in direction of the service. The person who presented with challenging behaviour was used as an example to illustrate the point. This issue is the subject of separate correspondence with the Society. The Society of St James has an annual development plan that includes the service at Avondale. Targets and goals are set out for the home. There was evidence during the site visit that surveys are carried out with people covering specific targeted areas of the service, e.g., activities, the garden, and disability access. These take the form of questionnaires; the results of which are used by the Society to improve the service. The manager confirmed that new satisfaction questionnaires are in the process of being developed to survey people, including relatives annually. In addition, residents meetings are planned for the near future. The Society is currently going through the process for achieving the Investors in People Award. The home prefers the residents’ representatives to take responsibility for their financial affairs. However, with the needs of the current resident group it is appropriate to have in place a system to safeguard the monies of those who are unable to make other arrangements. At the site visit we checked the system by way of dip sample and found it to be in good order, with receipts for purchases kept. Transactions were accurately recorded and balanced against expenditures. The home’s pre-inspection information sent to the Commission by the manager confirmed that policies and procedures are in place to ensure safe working practices in the home. A sample of records was viewed during the site visit including public liability insurance, electrical appliance and wiring tests, and gas boiler servicing. It was noted that the last recorded fire alarm test was 4 February 2008, having been recorded regularly up to that point. The manager said the tests were Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 26 being carried out but not recorded. It is important that consistent attention is paid to fire safety to ensure that people are not put at risk. Staff training records showed, and staff confirmed that statutory training is scheduled and updated in manual handling, first aid, fire training, infection control and food hygiene. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • There are robust systems in place for the day-to-day management of the care home, including financial processes, physical maintenance, general administration and management of clients’ records. There are appropriate levels of insurance in place, and staff are on duty 24 hours per day, seven days per week all year. We have improved communication between the care home and the Responsible Organisation by providing better IT equipment and e-mail facility. Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 27 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 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x 2 x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 2 Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1. OP7 Regulation 13 Requirement Where risks to vulnerable people are identified a risk assessment must be completed to set out the measures taken by the home to minimise the risk. This is to ensure that risks to vulnerable people are kept to a minimum. Where incidents occur that put people at risk of abuse safeguarding reporting procedures must be implemented. This is to ensure that Social Services as the lead agency in matters of safeguarding adults have an opportunity to decide on the action to be taken. Suitable screening must be provided in double rooms. This is to ensure privacy for personal care. Regular fire alarm tests must be carried out and recorded. This is to ensure as far as practicable the safety of people who use the service. Timescale for action 16/05/08 2. OP18 13 16/05/08 3. OP24 12 31/05/08 4. OP38 13 (Sch 4) 16/05/08 Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Avondale Residential Care Home DS0000068610.V361279.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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