Random inspection report
Care homes for older people
Name: Address: Avonwood Manor 31-33 Nelson Road Branksome Poole Dorset BH12 1ES two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gloria Ashwell Date: 2 0 1 0 2 0 0 9 Information about the care home
Name of care home: Address: Avonwood Manor 31-33 Nelson Road Branksome Poole Dorset BH12 1ES 01202763183 01202751530 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Avonwood Manor Ltd care home 49 Number of places (if applicable): Under 65 Over 65 49 49 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 0 0 One named person (as known to CSCI) under the age of 65 may be accommodated to receive care. Date of last inspection Brief description of the care home Avonwood Manor is registered to provide accommodation and personal care for up to 49 residents who suffer from mental disorders or dementia above the age of 65. Avonwood Manor is still owned by Avonood Manor Ltd, however the home is managed through Affinity Care Homes Ltd. The home is situated in a quiet residential area close to the shops and amenities of Westbourne. The home is made up of two large properties that have been joined by an
Care Homes for Older People Page 2 of 11 Brief description of the care home extension. Each of the properties has three floors and there is a passenger lift at either end of the home. Communal areas are located on the ground floor and there are well maintained and enclosed gardens leading from the back of the home that residents can access. The majority of the bedrooms are for single occupancy with en-suite WC facilities; however there are eight double rooms, in which portable screens are provided. At the front of the home there is parking for staff and visitors. The fees for the home can be obtained from the manager. Care Homes for Older People Page 3 of 11 What we found:
This focussed inspection was undertaken in order to view the homes progress towards meeting the requirements of the key inspection which took place on 18 June 2009, which determined that the quality rating was 0 star service, meaning that the people who use the service experience poor quality outcomes. The outcome area reviewed at this inspection related mostly to health and social care provision, the quality of life experienced by people living at the home and staffing arrangements. The inspection was unannounced, and carried out by 2 Regulation Inspectors. The inspectors toured the premises and spoke with service users and staff, and examined records and discussed progress with the Manager of the home and the Regional Manager of the provider organization. Because people with dementia and/or complex needs and ways of communicating are not always able to reliably tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this Short Observational Framework for Inspection (SOFI). This involved our observing some people who live at the home and recording their experiences at regular intervals. This includes their state of well being, and how they interacted with staff members, other residents, and the environment. What the care home does well:
We toured the premises and saw that redecoration of part of a first floor corridor has commenced, radiators have been covered to reduce risks of accidental scalding and some bedrooms had new furniture. The manager said that since the last inspection the home has improved provision of meals by offering residents a choice, and that they make their selection from the menu a day in advance of the meal being served. We discussed this process with the manager and expressed our doubts at the suitability of inviting people with short term memory loss to select meals a day in advance and the manager agreed that some associated problems had been experienced so the home is in the process of exploring alternative ways of menu selection. The manager told us that the home employs an Activity Coordinator who works 4 days one week and 3 days the following week, that a range of activity equipment had been purchased and that occasional minibus outings have recently taken place. On the day of inspection there were enough staff on duty to properly meet the needs of the residents. Since the last inspection the home has employed two new Care team Managers and two new care assistants, thereby enabling reduction in the employment of agency staff. Care Homes for Older People Page 4 of 11 The use of pressure mats and bed rails is now subject to assessment and review, and teh use of pressure mats has significantly reduced during recent weeks. Regular fire drills take place and staff receive training in fire safety at the required frequency. The home is in the process of arranging for staff to receive training in other subjects, including dementia care. What they could do better:
Health and Social Care We examined the records of three people who had been admitted to the home since the last key inspection and found that or two there was no evidence of pre-admission assessment. The manager told us this was because both had been emergency admissions. We checked the homes written policy and procedure for admission and found there was no reference to processes for emergency admission. For the third person preadmission assessment had been recorded but provided insufficient information to enable staff to gain a proper understanding of the persons needs and circumstances. Records of one of the people who had been admitted to the home without prior assessment indicated that the person was not in agreement to being in the home and had made unsuccessful attempts to leave, because staff kept the person under observation, and locked all accessible doors and windows. For this person there was no evidence that the home had recorded an assessment of mental capacity and had considered the implications relating to the deprivation of liberties. This person was recorded to have been refusing to eat meals at the home, and to need additional fluids due to a health condition, but the home was unable to supply to us evidence of what the person had eaten or drunk throughout the few days spent in the home. The homes records stated that the person had returned home, but the following night staff recorded that on their regular checks they had found the person asleep, thereby providing further evidence of the poor standards of record keeping. We examined recent Medication Administration Records (MARs) and found that staff were not handling medicines at the required standards of safety and accuracy. For example there were many occasions when medicines had not been signed for by staff, to confirm they had administered them to the residents for whom they were prescribed. A person prescribed a medicine twice a day was recorded to have received it three times on a recent occasion. For a person prescribed to receive a pain reducing medicine 3 times a day, signatures confirmed that on a recent occasion it had been given 4 times in one day but thereafter was administered haphazardly i.e. given in the morning, but not again that day, given at lunch time the following day and not given thereafter, apparently because the home had run out of the medicine and had failed to order a replacement stock. Records showed that because the medicine was unavailable 9 doses had been omitted. For a number of medicines, the administration instructions on the MAR had been altered
Care Homes for Older People Page 5 of 11 by staff, apparently on the instruction of the prescribing doctor, but the handwritten alterations were unclear and hard to follow, and may have led other staff to administer the medicines at the wrong frequency or dosage. Environment In many areas there was a strong and unpleasant smell of urine, boxes of vinyl gloves were openly stored in a bathroom where they pose suffocation risks to mentally frail people who might place a glove in their mouth, bathrooms were sometimes rendered unusable to residents because they were being used to store large items such as a hoist, seat scales and waste bins. Daily Activities When we arrived at the home we saw a number of residents in lounges looking drowsy and some apparently asleep. We spent the greatest part of our visit in the lounges, observing the interaction of staff with residents. There was a lack of visibly available items for residents to interest themselves in, we saw no books, newspapers, magazines, games, rummage areas or any other items in the communal areas where residents were seated. We saw a resident happily playing with a noisy percussion instrument, but within minutes a care worker approached, removed the instrument and a short while later gave the resident a greetings card to look at, and immediately left the area. The resident had no interest in the card and put it aside, and thereafter sat with nothing to do or to be interested in. We sat in the conservatory of Selborne lounge, where despite the radio loudly playing popular music, recorded old time music could be heard playing in the adjoining lounge. The impression was of undesirable noisiness unsuited to a living environment for older people with mental frailty. We saw a resident seated in the lounge with on his lap a small basket of dry leaves. The resident appeared uninterested in the leaves and no staff were nearby to engage him in a related activity such as discussion or sensory awareness. The SOFI observation was abandoned after a short while because it was apparent that staff were contriving to engage residents in unplanned activities whenever the inspector carrying out the observation appeared, but then allowing the activities to stop as soon as they had started when she left the room. Avonwood Manor is a large home, registered to accommodate up to 49 older people. It is unlikely that the employment of a part time Activity Coordinator is sufficient to properly meet the social and recreational needs of the residents, particularly as most would find participation in large group activities difficult due to their mental and physical frailties and accordingly need small group or one to one input. The home is recommended to employ additional staff, designated to the provision of recreational activities. Care Homes for Older People Page 6 of 11 We were told that arrangements are underway for staff to receive training in First Aid, so that soon the home will always have on duty a competent person. The manager is in the process of applying for registration with the Commission. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must 18/08/2009 ensure that the needs of people are fully assessed and kept under review To ensure that the home is able to provide the nursing care that each person needs 2 7 12 The registered person must 16/09/2009 ensure that people living at the home have an up to date plan of care that is sufficiently detailed to meet their health and welfare needs. To ensure that staff have accurate and detailed information to meet each persons needs 3 12 16 Arrangements must be made 17/10/2009 to consult service users about a programme of activities and provide facilities for recreation having regard to the needs of the people living in the home. This will ensure that all people will have the opportunity to engage in a recreational and stimulating activities. Care Homes for Older People Page 8 of 11 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 4 18 13 Arrangements must be made 21/08/2009 , by training staff and other measures, to protect people from risk of harm or abuse. This will ensure the safety and well-being of all people living at them home. 5 29 18 The registered person must ensure that staff receive training appropriate to the work they are to perform. This would include person centred dementia care, challenging behaviour, infection control and pressure area care. To ensure that the needs of people living at the home have their needs met. 17/12/2009 6 33 24 The registered person shall 17/12/2009 establish and maintain a system for reviewing and improving the quality of care provided at the home. This will ensure that all areas of the home are monitored in a systematic way. 7 38 13 The registered person shall 17/12/2009 make suitable arrangements for the training of staff in first aid. This will ensure that all shifts are covered by a first aider and protect people living at the home. Care Homes for Older People Page 9 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 8 All records should bear the full name of the person writing them i.e. it is insufficient to record only the forename, the surname should also be recorded. The home should employ additional staff, designated to the provision of recreational activities. To ensure the rights of people are properly protected, the home should develop and implement processes for the assessment of mental capacity, and to ensure compliance with Deprivation of Liberties provisions. The home should assess the safety requirements of potentially hazardous items including vinyl gloves, which can cause accidental injury and death if handled improperly. 2 3 12 18 4 38 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
