Inspection on 21/07/05 for Avonmead Nursing Home

This inspection was carried out on 21st July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Avonmead Nursing Home 24/03/09

Avonmead Nursing Home 14/05/07

Avonmead Nursing Home 19/06/06

Avonmead Nursing Home 16/01/06

Avonmead Nursing Home 02/02/05

Avonmead Nursing Home 19/08/04

Avonmead Nursing Home 04/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Avonmead Nursing Home 11 Canal Way Devizes Wiltshire SN10 2UB Lead Inspector Susie Stratton Unannounced 21st July 2005 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 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. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Avonmead Nursing Home Address 11 Canal Way Devizes Wiltshire SN10 2UB 01380 729188 01380 729299 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Sharon Cottrell Care home with nursing 45 Category(ies) of OP Old age - 45 registration, with number PD Physical disability - 4 of places TI Terminally ill - 4 TI(E) Terminally ill - 4 Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The maximum number of service users who may be accommodated at any one time is 45 No more than 4 service users between the ages of 18 and 65 years with a physical disability may be accommodated at any one time No more than 4 service users with a terminal illness may be accommodated at any one time The minimum staffing levels set out in the Notice of Staffing issued by Wiltshire Health Authority and dated 28 May 1999 must be met at all times No more than 4 service users over 55 years of age who are in receipt of Intermediate Care are accommodated at any one time. Date of last inspection 2 February 2005 Brief Description of the Service: Avonmead is a purpose built care home situated on the outskirts of Devizes, within a private housing development, providing nursing and residential care. The home has single and double en suite accommodation for up to forty-five persons distributed over two floors and served by a passenger lift. The home has an enclosed garden and patio area. The owner of the home is Laudcare Limited, a wholly owned subsidiary of Four Seasons Health Care Limited, a national provider of care. The manager of the home is Mrs Sharon Cottrell, she has been in post since the home opened. She is supported by two senior sisters. Two qualified nurses are on duty at all times supported by care assistants. An activity person is employed. Catering, cleaning, maintenance and laundry services are also available. Shops and local facilities are a short driving distance from the home in the Wiltshire market town of Devizes. There is ample parking on site. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Avonmead was inspected on Thursday 21 July between 9.35am and 5.10pm, in the presence of Anita Keegan, senior sister. During the inspection, the Inspector also met with three other registered nurses, five care assistants, the activities coordinator, the chef, the administrator and a domestic who was acting as a laundress. The Inspector also met and spoke with thirteen residents, three of whom had been admitted for intermediate care and observed care for seven residents who were unable to communicate. The Inspector reviewed records relating to seven residents in detail and toured the home. Other records examined included medicines records, residents financial records, residents’ files, the complaints log, minutes of meetings and staff rosters. What the service does well: What has improved since the last inspection? The kitchen has been fully cleaned. All staff who handle food reported that they have received food handling training. A staff meeting has taken place. There are very few other areas which have improved, only two of the seven requirements from the previous inspection had been met and none of the recommendations had been met in full. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 6 What they could do better: The home needs to ensure that they have evidence that all residents have been given contracts/terms and conditions of residence. This has been outstanding for two inspections. There needs to be a safe system for properly documenting all items handed in by residents for safe keeping. Systems are needed to ensure that residents’ moneys which are banked are held in individual accounts. This has been outstanding for the past two inspections. Residents who are assessed as being at risk of pressure damage need clear care plans detailing how risk is to be reduced. Equipment which does not reduce risk must not be used. Frail residents who need their needs attending to frequently and/or their food intake monitoring often do not have records completed, so it is not possible to assess if such frail residents have their needs met. Poor completion of such records was identified at the previous inspection. Residents who wish to self-medicate do not have secure facilities in which to store their medicines, this has been outstanding for the past two inspections. Residents with complex manual handling needs and those who need grab rails in their en-suites are not all provided with relevant equipment/aids to ensure their and their carers’ safety. Issues relating to variable height beds have been identified at the past two inspections. Intermediate care contracts should be reviewed, to ensure that systems are in place to meet service users’ needs. Care plans for diabetic service users should be more precise. Residents are not taken out of the home on outings and this is an area which needs development. Recommendations about staff availability to support residents on outings have been identified at the previous two inspections. Attention needs to be paid to cleanliness across the home to ensure that all equipment and furnishings are clean. An immediate requirement notice was issued to ensure that sanitary items are properly cleaned. One sluice room needs a full deep clean. Clinical waste needs to be properly disposed of in appropriate containers. Different types of laundry must be fully separated and systems must be put in place to ensure that residents’ clothing cannot be used communally. Systems should be put in place to ensure that all resident clothes are marked. Disposable gloves and aprons must be provided and used by staff in all relevant areas of practice. The home’s policy on staff uniforms should be revised to reflect current infection control guidelines. Appropriate British Standard signage is needed in all areas where oxygen is in use or stored. An audit of residents needs for door locks and lockable facilities for valuables in their rooms is needed; this has been outstanding for the past two inspections. A damaged disabled bath needs to be repaired or replaced. The suitability of current bathing facilities for disabled residents should be reviewed. The corridor carpets are deteriorating and should be replaced. New pots, pans and cooking trays should be provided to replace old or damaged items. The sugar content of manufactured foods should be considered before serving to diabetic residents. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 7 The home must comply with its required minimum levels for management hours for the nurse in charge, to ensure proper staff support and supervision. An immediate requirement certificate was issued about this at the end of the inspection. At the past inspection, the home has been required to review staffing levels, to ensure that there were enough staff to meet residents’ needs, this has not taken place. Staff rosters should show when staff are working into different roles. Response times when resident use their call balls should be assessed. Evidence needs to be available to show that all staff receive formal supervision. The home is registered to care for persons with a terminal illness, so some staff should attend the relevant course on death, dying and bereavement, this has been recommended for the past two inspections. The activities coordinator should also be supported in attending an activities coordinator course. The manager of the home needs to show that she is able to perform the role of registered manager by taking action on requirements, ensuring that residents’ wishes and needs are respected and ensuring that all complaints are documented and complainants informed of outcomes when they do raise issues. The need to properly document complaints has been identified for the past two inspections. Staff meetings should be minuted and made available. 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. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 & 6 Self funding residents may be put at risk as there is no evidence that they have been provided with a contract. Residents are assessed by a person with appropriate qualifications prior to admission, to ensure that their needs can be met. The home needs to ensure that the purchasers of intermediate care ensure that all needed supports are available to the service user. EVIDENCE: At the inspections of 3rd February 2004 and 18th August 2004, it was required that every service user admitted to the home must be issued with a statement of terms and conditions. At the inspection of 2nd February 2005, it was reported that contracts were likely to be available soon. A review of three files of self-funding residents at this inspection provided no evidence that they had been given a written contract or statement of terms and conditions. Service users are written to by the manager, but there is no reference to a contract in the letter. The home’s statement of purpose, which is on display in the front hall, does not include a service users’ guide with the terms and conditions. Residents who are funded by the County Council have the County Council’s contract on file. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 10 The files of recently admitted residents showed that they had had a full and detailed assessment performed by the home manager or deputy, prior to admission. The manager or her deputy always meets with the resident personally, as well as obtaining copies of relevant assessments. All residents admitted for intermediate care have their own rooms, where rehabilitation can be carried out. Full evidence that all needed specialised equipment was not available (see Standard 22). Service users admitted for intermediate care, who are not from the locality are registered as a temporary patient with a local GP. Evidence from this inspection showed that local GPs were unwilling to review treatments, unless in an emergency as intermediate patients were not permanent patients. This means that intermediate care service users’ medication and medical needs could not be met at all times. Additionally some service users admitted for intermediate care were not reviewed by the intermediate team regularly and regimes reviewed according to their needs, although there was evidence that staff in the home had regularly sought review. In order to ensure that intermediate care provision is effective, the home should seek a review of how the service can be improved with the purchaser, to ensure that service users admitted for intermediate care have their needs met. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Residents are protected by clear care plans, however residents at risk of pressure damage may be put at risk by a lack of consistent approach in the provision of appropriate care and equipment. The home is not providing evidence that it is fully supporting frail residents who need frequent care. Staff record and administer medicines in a safe manner, however a lack of secure lockable storage facilities in residents own rooms means that safe systems are not in place for residents to wish to self medicate. Staff work hard to ensure residents’ dignity, but difficulties with the laundry service means that residents have their personal clothing available to them at all times. EVIDENCE: All residents have clear and detailed care plans in place, which direct care. These plans are regularly reviewed and there was evidence of consultation with the resident or their representative. There was clear evidence of consultation with residents’ GPs and other healthcare professionals. Where residents had wounds, documentation relating to the wounds was clear and completed in such a way as to ensure that the wound’s response to treatment could be assessed. All residents are assessed for manual handling needs, with clear care plans in place to direct staff on how these needs are to be met. Residents are assessed for risk of falls and care plans put in place to reduce risk. As Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 12 footwear can be a factor in risk of falls, this should be included in the assessment. Documentation and provision of equipment for prevention of pressure damage is confusing. All residents are assessed for risk of pressure damage but only one of the records inspected documented what equipment was to be used to prevent pressure damage and that related only to the resident’s bed, not their chair. Two residents who were assessed as having a high risk of pressure damage had a mattress on their bed which does not reduce pressure and can cause pressure damage, if it is not new. Some residents assessed as being at high risk of pressure damage had equipment which was consistent with that risk on their bed but others did not. The same applied to provision of pressure relieving cushions to chairs. Prevention of pressure damage is not being properly managed and some residents may be at risk. The home cares for several residents with a diabetic condition and clear records of their treatment regimes are maintained. One such resident’s care plan stated that their blood sugar levels should be kept within normal levels, without specifying what the normal levels were for that resident and what their GP or diabetic nurse wished nursing staff to do, if the resident’s blood levels did not fall within these specified levels. Care plans should clearly state blood levels and what actions should be taken, to ensure that treatment plans are as effective as possible. Some frail residents have documents in their room on which to record how often they have been turned, provided with fluids and what they have eaten for their meals. These charts were very variably completed. The home cannot provide evidence that they are meeting the care needs of such frail residents. Inadequate completion of such records was observed at the previous inspection. All systems relating to administration and records for the administration of medicines were properly maintained. The registered nurses were knowledgeable about the action of drugs used in the home. Administration of Controlled Drugs was performed in a safe and effective manner. Two residents wished to self-medicate and some others were partially self-medicating. Residents’ bedrooms do not include a lockable facility to ensure that medicines and personal items can be securely stored. A requirement for a secure lockable facility in residents’ room had been set for the past two inspections. This has not been addressed. This is of particular concern as this inspection showed that on occasion the home have cared for residents with a dual diagnosis who can wander into other resident rooms and pick up objects. All staff knocked on residents’ doors prior to entering and all care was performed behind closed doors. It was much to the credit of staff that despite the pressure on them in relation to staffing (see Standard 27 below), they remained polite, supportive and helpful to residents at all times. Residents’ Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 13 dignity may be compromised by the communal use of net underwear, poor management systems for personal laundry and the problems with the management of potentially infected laundry (see also Standard 26 below). Two residents said that their laundry took a time to come back. One resident said that “things disappear” in the laundry. One commented on the poor quality of the ironing. There does not appear to be a consistent system in place to ensure that residents’ clothing is marked. The laundress reported that she always has a range of items which she does not know to whom to return them. Residents may arrive in the home, particularly those needing intermediate care, with only some or none of their laundry marked. If this then needs to go to the laundry, the laundress will not know to whom the items belong. None of the net underwear inspected had been marked. No residents were dying at the time of the inspection. It was noted that no staff have been sent on a death and dying course as recommended at the previous inspection, so the home cannot demonstrate that it has staff with an up-to-date knowledge on how to care for residents at the end of their lives. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Activities are provided in the home but this is often limited as the activities coordinator has to cover for other staff. Residents are supported in maintaining links with friends and family but the home does not provide outings, so many residents never go out of the home. Residents gave varied opinions on the meals provided. Standards of meals and presentation are generally satisfactory but attention is needed to some areas. EVIDENCE: The home employs an activities coordinator, who has a programme of activities, this is available to all residents in their rooms. The activities coordinator reported that she had developed the programme by discussion with residents and staff. She has not attended an activities coordinators course to support her in her role. It was reported by a range of staff that the activities coordinator is not always available to provide activities and that at various times she had had to help out as a carer, domestic, in the kitchen or in the laundry. There was verbal evidence that this had happened three times on the week before the inspection. As staff do not have opportunity to support the activities coordinator in her duties, when she is not available, activities are not provided to residents. Residents reported that their families and friends were free to visit the home when they wished. Several residents said that they went out with family members. The home does not arrange outings for residents and the activities Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 15 coordinator reported that she felt it would benefit residents to do so, especially those who were not visited often. She reported that she does take residents out individually to Devizes, but she cannot do this in a group, due to the transport available and lack of availability of other staff. At the previous inspection, it was recommended that a review of staff hours took place in order to provide more one to one contact and occasional outings, there was no evidence that this had taken place Residents gave a varied response to their opinions of the meals, these included comments like “I enjoy them”, “Not at all bad”, “all right”, “usually fine, but they have a few hiccoughs”, “variable” and “rock bottom”, this person said that if they did not like either choice, they had to go without. This was also reflected in the minutes of the resident meetings. Residents are offered a choice of meals. The chef serves meals individually and they are attractively presented. There are two dining rooms in the home, one on each floor. The ground floor dining room was only used by a few residents. It was an attractive area, with table cloths and flowers on the tables. The first floor dining room is part of the first floor sitting room. It was used by more residents. It was noted at the start of the inspection that one of the dining room tables was not clean, with dried encrusted food visible on its under surface, also four of the dining chairs were sticky. Staff sat with residents who needed support at mealtimes, assisting them to eat. The chef showed a good knowledge of which residents needed special diets. It was found that the yogurts and dried soups, which are both used for diabetics, contain significant amounts of sugar and the chef was advised that she should look at the sugar content of manufactured foods before giving them to diabetics. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has begun to take some action on the recording of complaints, however some residents were not confident that all matters they brought up had been listened to and action taken. EVIDENCE: For the past two inspections, the home have been required to ensure that all complaints are recorded and investigated, and that the complainant receives feedback regarding the outcome where appropriate. A review of the complaints log showed that some work had commenced on this and that three verbal complaints had been documented since the previous inspection. During this inspection, several residents expressed concerns to the Inspector about the laundry service, meals, response times when they used their call bell and staffing. Many said that they had brought these matters up in the past but, there was no evidence in the complaints log that these had been documented. One resident said they would take any concerns to “Matron”. Another said that they felt they could talk to any of the staff. Several residents did say that if they had concerns about care provision, they would bring it up with the nurse in charge of the floor and many said that this nurse would make sure that their concerns were addressed, if it was within their ability to do so. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 26 Residents at Avonmead have access to a range of communal spaces, as well as their own bedrooms. Both residents and staff may be put at risk by inadequate provision of equipment for disabled and frail persons. A major risk to cross infection for residents is in place from a wide range of equipment, practice and procedures in the home; several items of equipment were not clean, others not properly maintained and others not available for staff. EVIDENCE: A recent visit to the home by the fire safety officer resulted in the issue of enforcement Notices by Wiltshire Fire Brigade, to ensure the safety of residents, staff and visitors to the home. At this inspection, it was noted that three residents were prescribed oxygen and had cylinders in their rooms, oxygen is also stored in the home. Approved British Standard signage was not placed on the door of the rooms where oxygen was stored or in use. Most of the rest of Avonmead appeared to be well maintained. Some of the corridor carpets were showing signs of staining and will need replacement in due course. The kitchen cooking pots and trays look old and some will need Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 18 replacement. The chef reported that she had asked for more but that this had not been agreed to as yet. Sitting and dining rooms are provided on each floor and there is a pleasant patio outside to the rear of the building. A range of wcs and baths are available. There is only one variable height bath in the home, all of the other baths are low and may present a risk of back injury to staff. There are no disabled showers in the home. One of the baths has been scraped by the bath hoist and the enamel is no longer intact. As this is a communal bath, this presents a major risk to cross infection as the bath cannot be properly cleaned if it has a damaged surface, and there is a high likelihood that micro organisms could multiply in the warm, wet environment of a bath. Most of the residents are cared for in single rooms with en-suite facilities. Where rooms are shared, screening is available. At the two previous inspections, the manager had been required to carry out an audit to ascertain whether residents require door locks for their rooms and lockable storage place for valuables. This has not taken place. It was recommended at the last inspection that the manager should audit to ensure that adjustable beds were provided where indicated. This has not taken place. There are some variable height beds for residents, however over five residents who had complex manual handling requirements had not been provided with variable height beds, one of these was a resident who had been admitted for intermediate care. As noted in Standard 8, above there is an inconsistency in provision or pressure relieving equipment and this also included some service users admitted for intermediate care. Two residents described to the Inspector how they used their en-suite facilities and that they needed to use the wash hand basin as a hand rail as sufficient grab rails were not provided in en-suite rooms. This is a risk to residents and does not assist in rehabilitation. Residents responded variably about staff response to the call bell, one said that “staff come running” when they used their bell, another said “If I ring my bell, they come quickly”, however another said that staff “sometimes” came when they used their bell and another said that staff did not come quickly. The home has very poor systems in place to ensure cleanliness or procedures to prevent cross infection. All of the raised toilet seats, five toilet rails, four commode chassis and the bath hoist on the first floor were not clean showing staining, and yellow and/or brown debris on their undersides. An immediate requirement certificate was issued at the inspection, to ensure that such items were cleaned. Both the non-slip mats inspected were not clean on their undersides and had been left wet after use. The sluice room on the first floor needs attention, the walls of the room are stained in places, the floor around the washer disinfector was not clean and the washer disinfector was encrusted with what appeared to be brown stained lime-scale. None of the sluice rooms Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 19 had gloves or aprons available and one member of the care staff was observed to wash commode buckets without using gloves. Sluice rooms need to be maintained at high standards of cleanliness to prevent micro organism growth and staff need to prevent risk of cross infection by being provided with appropriate equipment and use correct procedure. The home should review its policy and procedure on staff uniforms to reflect current Health Protection Agency guidelines on prevention of risk spread of infection from potentially contaminated uniforms. At this inspection, one clinical waste bin was not foot-pedal operated, the lid of another bin was broken and one yellow bag for clinical waste had been tied to the tap of a resident’s wash hand basin. If there are not safe systems in place for disposal of clinical waste, there is a risk of cross infection. All clinical waste must be placed in foot pedal operated bins, to prevent hand contamination. The laundry was clean, including behind the washing machines. The home has two washing machines, both of which have a sluice wash programme. An effective management system for laundry is not in place. Staff often place all contaminated or potentially contaminated laundry together in a red bag. This means that the laundress may wash residents’ personal clothes in a sluice wash at a temperature which will damage these clothes. The laundress reported that, if she notices that residents‘ clothes have been put in with sheets, she re-sorts the items. This is a risk, as contaminated and potentially contaminated laundry must be handled as little as possible to prevent cross infection. Other laundry is placed in bags on trolleys next to shelves for clean linen. This means that there is a continued potential for clean linen to be cross-infected. Used linen must always be separated from clean linen. The laundress re-sorts the linen once it comes to the laundry room, this is a risk, as systems need to be in place to ensure that all laundry is handled as little as possible. The laundress is not protected, gloves are available but, there were no disposable aprons in the room. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home are not complying with all parts of its Staffing Notice, this puts residents at risk. A review of staffing levels has not taken place and this inspection shows that there are continued issues in staffing the home. EVIDENCE: Avonmead are required to staff their home in accordance with a Staffing Notice issued by their previous registering authority. A review of staff rosters showed that the home were doing this in part, although some staff work long hours. Agency staff are not used. The home is failing to comply with the management hours for the home. At the time of the inspection, the registered manager was supporting other home(s) within the group and the two senior sisters were acting into her role. The Commission had been informed of this. For the week commending 4th July there was no evidence of any management hours, for the week commencing 11th July, there was evidence of approximately twelve management hours and the week commencing 18th July, there was evidence of approximately thirteen hours. The home’s Staffing Notice requires the manager or sister-in-charge to work 35 hours in addition to the registered nurses on duty. The effect of this is that staff are not supervised in their roles, which may explain why discrepancies in the laundry service, standards of cleanliness, record keeping and recording of residents valuables (see Standard 35 below) were noted at this inspection. An immediate requirement certificate was issued to ensure compliance with the home’s Staffing Notice. Residents reported to the Inspector on the lack of staffing. One said that the home was “short of staff” and another that staffing of the home was “rock Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 21 bottom.” This has also been reported in residents meetings. On the day of the inspection, staff were observed to be busy and they did not commence personal care for one resident until 11.45am, the resident reported that this was due to staffing, not their preference, they did say that if they asked to have their personal care given earlier, this was respected. There was evidence that when the home was short of staff that the activities coordinator performed different roles (see standard 12 below), this is not documented on the staff rosters. It was reported that two of the ancillary staff were on long-term sick leave. The number of cleaners on the roster appeared to be low for the size of the home. At the previous inspection it was required that the registered manager review the current staffing levels to ensure that adequate staff are available to meet the residents needs at all times. This has not taken place. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 22 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 35 The manager cannot provide evidence of her competency, as she has not met several requirements identified at the previous inspection and basic care provision is not in place in a range of areas. The home cannot evidence that it is run in the best interests of residents, as issues raised at several meetings by residents and staff have not been acted upon. Records are available of residents’ personal moneys but interest is not accrued on accounts and there is an unsafe system in place when valuables are handed in for safekeeping. EVIDENCE: Mrs Cottrell has managed the home since it opened, she is a registered nurse. Five requirements from the previous inspection have not been addressed and two of these have been outstanding for more than one inspection. Three of the four recommendations had not been addressed and one had only been addressed in part. This, and the fact that so many requirements relating to basic care have been identified at this inspection, means that the manager cannot demonstrate that she is able to properly discharge her responsibilities. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 23 At the previous inspection it was recommended that a general staff meeting should be held in order to discuss issues of concern amongst staff. Staff meetings are being held, however they are not minuted, so matters raised and action points from them cannot be identified. Residents meetings are also held, the past three all identify issues with the laundry service, meals and staffing, there is no evidence to show that action has been taken to address these matters. Supervision records could not be reviewed at this inspection, as the manager was not available. The sister in charge reported that requirements from the previous inspection relating to supervision were in progress. It was noted that a range of residents’ personal items had been stored in a container in the home’s safe, for a period of time. Some of items were in envelopes, some were not. Only some envelopes stated the resident’s name, only some of these had the date they were handed in on them, some of these were dated as having been handed in as long ago as 2003, some envelopes no longer contained any items. There was no evidence that an audit trail of valuables handed in was in place or that relatives had been contacted about these items or of regular audit of such valuables takes place. It was required at the previous inspection that residents gain interest accrued on their personal accounts individually, which is fair and proportionate to their level of funds. A similar requirement was made at the inspection of 19th August 2004. At this inspection a review of records showed that the home maintains individual records of residents’ moneys, including receipts, however the actual moneys are all kept in one interest-bearing account. It was not clear as to what occurred to any interest accrued on this account. Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 1 3 x x 2 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 2 COMPLAINTS AND PROTECTION 2 3 3 2 3 2 x 1 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 2 x 2 x 1 x x x Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 5 (1)(b) Requirement There must be written evidence that every service user admitted to the home is issued with a contract/statement of terms and conditions, which contains all the matters detailed in National Minimum Standard 2.2. (Unmet requirement from the inspections of 3 February 2004 and 19 August 2004) All service users assessed as being at risk of pressure damage must have a care plan to detail how risk is to be reduced. Care plans must be consistent with current research based evidence. Equipment which does not prevent damage and may increase risk of pressure damage must not be used. Where frail service users care needs to be monitored by use of a frequent care chart and/or food chart, these records must be fully completed on all occasions. When service users wish to self medicate, a suitable secure facillity must be provided to them in their rooms. (Unmet requirement from the Timescale for action 30 September 2005 2. 8 12(1)(a) 13(4)(c) 23(2)(n) 31 August 2005 3. 8 12(1)(a) 14 September 2005 4. 9 13(2) 23(2)(m) 14 September 2005 Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 26 5. 10 12(1)(a) 12(4)(a) 13(3) 22 (3)(4) 6. 16 7. 8. 19 21 23(4) (a)(c)(ii) 13(3) 23(2)(j) 13(4) (a)(b)(c) 23(2)(n) 9. 22 10. 22 13(4)(a) (b)(c) 23(2)(n) 11. 24 12(4)(a) 16(1) (2)(c) 23(2)(m) inspections of 19 August 2004 and 2 February 2005) Systems must be put in place to ensure that communal use of service users clothing does not take place. All complaints must be recorded and investigated and the complainant must receive feedback regarding the outcome. (Unmet requirement in part from the inspections of 19 August 2004 and 2 February 2005) British Standard signage must be placed on doors of any rooms where oxygen is in use or stored. The damaged assisted bath on the first floor must be repaired or replaced to prevent risk of cross infection. An audit of service users manual handling care plans must take place and the home must submit an action plan to the Commission, detailing when all service users with complex manual handling needs will be provided with a variable height bed. (This relates to a requirement from the inspection of 19 August 2004 and a recommendation from the inspection of 2 Feburary 2005, which as not been addressed.) An audit of service users needs for grab rails in their en-suite facillties must take place and the home must submit an action plan to the Commission, detailing when service users who are assessed as needing them, will be provided with grabrails. An audit to ascertain whether service users require door locks for their rooms and lockable storage facilities for valuables must take place. An action plan 14 September 2005 14 September 2005 14 September 2005 30 September 2005 12 September 2005 14 September 2005 14 September 2005 Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 27 12. 26 13(3) 23(2)(d) 13. 26 23(2)(d) 14. 26 13(3) 23(2)(d) 15. 26 13(3) 18(1) (c)(i) 16. 17. 26 26 13(3) 13(3) must then be developed and submitted to the Commission, detailing when they will be provided. (Unmet requirement from the inspections of 19 August 2004 and 2 February 2005) Safe systems, which conform to principals of prevention of spread of infection, must be in place for all sanitary items, to ensure that they are clean, free of staining and debris. (An immediate requirement certificate was issued at the time of the inspection) All items in the home, including dining room tables, chairs and bath mats must be free of debris, dust and staining. The sluice room on the first floor must be fully cleaned, including the walls, floor and the washer disinfector. All limescale and debris must be fully removed. A supply of disposable gloves and aprons must be available to staff in all relevant areas of the home, including all sluice rooms and the laundry. Managers must ensure that staff use these items whenever indicated. All clinical waste must be put in foot-pedal operated waste bins. Safe systems must be put in place, to ensure that used laundry is not placed next to clean laundry and that all types of laundry, particularly potentially infected laundry does not have to be re-sorted in the laundry. The manager and/or sister-incharge must always work 35 hours in-addition to the registered nurses on duty, as specified in the homes Staffing 4 August 2005 14 September 2005 14 September 2005 14 September 2005 14 September 2005 14 September 2005 18. 27 18(1)(a) 25 August 2005 Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 28 19. 27 18(1)(a) 20. 31 19(1) 21. 33 12(3) 22. 36 18(2) 23. 35 17(1)(2), Scedule (9)(a)(b) Notice. (An immediate requirement certificate was issued at the time of the inspection.) A written review of the current staffing levels must take place and be submitted to the Commission, to ensure that adequate staff are available to meet the service users needs at all times. This to include domestic, laundry and activities staff as well as nursing and care staff. (Unmet requirement from the inspection of 2 February 2005) The registered manager must provide evidence, by complying with requirements identified in inspections, that she continues to be fit to perform her role. Evidence must be available to show that service users wishes and feelings in respect of their care in areas such as laundry provision, meals, answering their call bells and staffing have been met. Staff must receive formal supervision at least 6 times a year. (This requirement was identified at the inspection of 2 February 2005, it could not be reviewed at this inspection) A full record of all valuables which have been handed in for safekeeping must be put in place. This must include the date when items were handed in, when next of kin were notified and when they were handed back to the next of kin. A full audit of items currently in store must take place and action taken to ensure that these items are returned to relevant persons. 30 September 2005 30 September 2005 30 September 2005 30 September 2005 30 September 2005 Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 29 24. 35 20(1) Service users must gain interest accrued on their personal accounts individually, which is fair and proportionate to their level of funds. (Unmet requirement from the inspections 19 August 2004 and 2 February 2005) 30 September 2005 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 6 Good Practice Recommendations A review of the intermediate care contract should take place, to ensure that service users have appropriate medial support and that the intermediate care team performs reviews in a timely manner. Care plans for diabetic service users should state precise blood sugar levels and actions to be taken by staff when these blood sugar levels fall outside these levels. A full review of the system for marking of service users laundry should take place, to ensure that responsibilites for marking of service users clothes, particularly those admitted for intermediate care and those without relatives, is made clear. Some staff should attend the death, dying and bereavement course. (Unmet recommendation from the past two inspections) The activities coordinator should attend a course on activities provision. The owners of the home should develop systems to ensure that service users can be taken out of the home on outings. (This relates to an unmet recommendation from the past two inspections.) The sugar content of manufactured foods should be assessed, to ensure that foods with a high sugar content are not given to diabetic service users. The corridor carpets should be replaced. New pots, pans and cooking trays should be provided to replace old and deteriorated stock. The suitablity of current bathing facillities for disabled serivce users should be considered and action plans put in Version 1.30 Page 30 2. 3. 8 10 4. 5. 6. 11 12 13 7. 8. 9. 10. 15 19 19 21 Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc 11. 12. 13. 14. 22 26 27 33 place to meet the needs of such service users. A system for review of response time by staff when service users use their call bells should be put in place. The homes policy on staff uniforms should be reviewed, to ensure that it conforms to current Health Protection Agency guideleines. Staff rosters should detail when staff such as the activities coordinator are performing other roles. All staff meetings should be minuted and made available to all relevant persons. (This relates to a recommendation from the previous inspection, which has only been met in part.) Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 31 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Avonmead Nursing Home DD51_D01_S15890_AVONMEADNURSINGHOME_V226560_210705_STAGE4.doc Version 1.30 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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