Inspection on 25/05/05 for Avonwood Manor

This inspection was carried out on 25th May 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 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

Avonwood Manor 08/12/09

Avonwood Manor 12/11/09

Avonwood Manor 20/10/09

Avonwood Manor 21/09/09

Avonwood Manor 17/06/09

Avonwood Manor 13/05/08

Avonwood Manor 25/07/07

Avonwood Manor 25/04/06

Avonwood Manor 28/10/05

Avonwood Manor 27/01/05

Avonwood Manor 16/04/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Avonwood Manor 31-33 Nelson Road Branksome Poole BH12 1ES Lead Inspector Gill Kennedy Unannounced 25 May & 6 June 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. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Avonwood Manor Address 31-33 Nelson Road, Branksome, Poole, Dorset, BH12 1ES 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) 01202 763183 01202 751530 Avonwood Manor Ltd Mrs Toni Sylvana Stevens CRH 49 Category(ies) of DE(E) - 49 registration, with number MD(E) - 49 of places Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: One named person (as known to CSCI) under the age of 65 may be accommodated to receive care. Date of last inspection 27 January 2005 Brief Description of the Service: Originally two houses, Avonwood Manor has been joined with an extension and now constitutes one building. The two areas of the building are referred to as Nelson (no. 31) and Selbourne (no.33) and operate as one home. The home is situated approximately fifteen minutes walking distance from the shops. Transport is relatively near and a local bus service runs to Poole, Parkstone and Bournemouth. The nearest shopping area of Westbourne offers a full range of facilities including banks, post office, chemist, newsagents, clothes and grocery shops. Avonwood Manor provides personal care for up to a maximum of 49 service users over the age of 65 years with a dementia type illness. The home is managed locally by Mrs T Stevens, who liaises with a regional operations manager of BML Healthcare Ltd, the managing agents. Community health services are provided (GP’s, district nurses, chiropody etc) based on individual need. There is an activities coordinator based in the home who provides a range of activities for small groups of service users Rooms are situated on three floors and both sections of the home have a passenger lift. The majority of rooms are single with en-suite facilities but there are eight double rooms. There is a secure private garden at the rear of the property and ample parking for visitors at the front of the home. The home has its own laundry and provides all meals from its central kitchen. A visiting hairdresser staffs a hairdressing salon on site each week. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection had been conducted as part of the normal inspection process legally required. On the first day of the inspection The Deputy Manager, Margaret Philips, was the senior person on duty and available in the home for part of the inspection. During this visit a follow up date was arranged to see the registered manager, Mrs Stevens. Both were helpful and co-operative and made themselves available to answer questions and provide documentation as needed. The files of three residents were read during this inspection. Four residents were spoken to and they appeared settled and contented, but their ability to express their views about the home were limited. CSCI comment cards were left for relatives, friends and professionals to complete. At the time of writing this report comment cards had been received from GP’s at three different surgeries. They indicated satisfaction with their contact with the home. Two health care professionals also expressed general satisfaction with the home, although one person said that there was not always a senior member of staff to confer with. Two relatives/friends also replied. They said they felt welcome in the home and one person said ‘I have always found the home to be very caring, they always inform us if anything is wrong with named resident. Six staff were spoken to, three care staff and three of the ancillary workers. A selection of bedrooms and the communal areas were seen during this inspection. Liaison took place with Dorset Social Services monitoring team who had visited the home in March and April of this year. The time taken on this inspection was 8.5 hours and 12 standards were inspected. The terms resident and service user used in this report are interchangeable. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The medicines policy must include information about actions required where medication has to be crushed before being given to residents. Improvements are also needed in the recording of medicines when they are written on the medication administration record and for those not supplied pre-packed. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 7 Residents are not offered an alternative, or asked if they would like the vegetarian option for their main meal served at lunchtime. Providing an alternative would enhance service user choice. Whilst policies and procedures are in place and training supplied to staff it would be beneficial if these could be further re-enforced in staff meetings and staff supervision. The home needs to make sure that water is supplied to residents at a safe temperature around 43oC at all times. The home has an ongoing training programme, but moving and handling training for six staff is several months out of date, and a future training date is scheduled for July. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 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 Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 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) 4 Formal notification needs to be provided to prospective residents after their assessment so that they know the home will be able to meet their needs. EVIDENCE: The deputy manager had recently attended a course on dementia and said she has cascaded some of this training down to senior care staff. Two care staff had recently attended a training course called ‘Understanding Dementia’, although one member of staff spoken to said it was not sufficiently targeted towards the type of residents she/he cares for. There is also in house training provided by Mrs Stevens for staff new to working with service users who have dementia. Information has also been sought from the Alzheimer’s Society about suitable courses that Mrs Stevens and her deputy could undertake. Currently, the home does not confirm in writing that they are able to meet residents’ needs, but Mrs Stevens will include this in the welcoming letter she sends out to residents being admitted to the home and this can be followed up at the next inspection. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8, 9 All residents had a detailed care plan which was regularly updated to reflect changing needs. Service users health care needs are promoted and maintained in line with their care plan. Systems for the administration of medicines need some adjustments to minimise the chance of mistakes being made and to safeguard residents. EVIDENCE: Three care plans were read during the inspection. Care plans were written in a clear and easy way with details for staff on what actions they needed to take when providing care for residents. Areas of particular concern and how they should be managed were highlighted in red. There were risk assessments and also a night plan. However, a member of staff showed outdated care plans as the document he/she was working from which were also accessible on each unit. Mrs Steven said she would ensure current plans were the only care plans staff referred to.` Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 11 It is not the policy of the home to weigh residents, unless there are concerns about weight loss. There are nutritional risk assessments and a record is kept of what service users eat. Evidence was seen that this is also noted on the daily record and Mrs Stevens says that staff would alert her if there were any issues and currently two residents are having their weights monitored on a regular basis. The home relates to eight GP surgeries and as far as possible residents retain their own Doctor on admission. Risk assessments are undertaken and where necessary a detailed plan is written indicating how staff should manage the resident and evidence of this was seen on care plans. The manager confirmed that the home works with the District Nursing services and one resident was currently being treated for leg ulcers. Specialist equipment would be provided by the DN service as required. The home provides incontinence aids until the resident has received a District Nursing assessment and evidence of assessments has been previously supplied to CSCI. There is a chiropodist who visits the home and service users have access other ancillary health services as required and this was noted on care plans. There are policies and procedures in place for the administration of medicines and staff were aware of how to access this information. Although Mrs Stevens did acknowledge that this did not include procedures for medicines that need to be crushed where this had been agreed by the GP. There is a list of staff who dispense medication, with a copy held of their full name and signatures. Staff who administer medicines have received training with their local pharmacist and an external provider. The monitored dosage system is used with MAR charts. It was noted that where medication had been handwritten this was not signed by two competent people as required. Also where medication was not in the monitored dosage system the date the box had been opened had not been recorded to provide a clear audit trail. The home has now developed a system to ensure they do not run out of medication. The Deputy Manager is also undertaking monthly audits and spot checks, having devised a returns sheet, to ensure that a close audit is kept for returned medicines. Controlled medication is stored securely. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 12 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) 14 and 15 Residents are able to do as they wish, but their ability to make informed choices is limited due to their illness. A wholesome and nutritious diet is provided with residents’ food intake being recorded. EVIDENCE: No-one in the home is capable of handling their own financial affairs and they are managed by their families or solicitors. Residents are able to bring in their possessions and evidence of this was seen. However, Mrs Phillips said families are advised to label all items and an inventory is kept. They are also advised not to bring in expensive items as residents wander into each other’s rooms and can move items around. Service users are encouraged to maintain as much independence and control in their daily lives as possible and this is noted on care plans. A discussion took place with the chef who works to a four-week menu. A vegetarian menu is also available, but there is only one person who has this. A member of the care staff team said there was only one vegetarian resident and other service users were not offered this option as they would be unable to recall what they had ordered. A four week menu was provided and this demonstrated a wholesome and balanced diet was provided. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 13 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) 16,18 The complaints procedure is readily accessible to enable residents’ and their representatives to express any concerns they have. Whilst home ensures that staff receive abuse awareness training to make them aware of the issues concerning vulnerable adults, systems need to be in place to ensure this information is retained and incorporated into everyday practice. EVIDENCE: Since the last inspection there has been one complaint investigated by Social Services, this had various strands to it involving the care given to service users and a loan obtained by a member of staff from a resident. None of the complaints regarding care have been upheld by the Social Services investigation, but it was acknowledged that a member of staff did accept a loan from a resident and as a result of this was disciplined. An apology was sent to the ex-resident and his/her relative. There is a complaints book and evidence was seen that a detailed record would be made of any concerns expressed to Mrs Stevens. Regulation 26 reports provided by the operations Manager indicate that the home has not received any complaints since the last inspection. The home’s complaints policy is made available in documentation provided to residents and their chosen representatives and is also displayed in the home. None of the care staff spoken to were clear about how the complaints system operates. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 14 There are two policy files, which include the ‘No Secret’s’ booklet based on Department of Health guidelines available in each section of the home, and staff said they would refer to them. The staff seen understood the different types of abuse, but one senior member of staff was unaware who the investigating authority would be in the case of an alleged incident, although he/she had received some abuse awareness training. Another staff member was unaware of the Whistleblowing policy. The training records show that the majority of staff (23) had received abuse awareness training over the last two years. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 15 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) 26 Residents are able to live in a clean and comfortable environment. EVIDENCE: The home was found to be clean with no malodours. The laundry is sited separately from the home. There are three industrial washing machines and facilities to wash foul laundry at appropriate temperatures. A laundry assistant is employed in the home. Dorset Social Services Contracts department had made some recommendations as a result of a recent visit and Mrs Stevens said the improvements had been implemented, apart from one as she felt it impractical to supply soap dispensers for residents in communal bathrooms as due to their illness they would be unable to work out how to use them appropriately. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 16 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 number of staff employed, and the skills they have, meet the needs of residents. EVIDENCE: At the time of the inspection the home was catering for forty-four residents. All service users admitted have either medium or high care needs. Mrs Stevens said she uses the guidance recommended by the Department of Health to calculate staffing numbers and puts on additional staff when the numbers in the home increase to forty-five. However, the manager did not have a current breakdown of the dependency levels of service users, which could also be an indicator for additional staffing levels. Two staff spoken to said they sometimes felt under pressure during the morning shift and this could vary depending upon residents needs. The staffing roster showed that six care staff are on duty between the hours of 8.00 and 20.00, four staff are on night duty. Ancillary staff are employed including the chef, cleaners, laundry assistants, secretary and a handyman. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 17 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) 37,38 The home has good recording systems, which are reviewed and updated on a regular basis. Systems and training are not fully in place to ensure the protection of residents. EVIDENCE: Care plans are kept securely and are regularly updated. Staffing rosters and training records are clear and when staff changes shifts this is clearly marked. There are corporate policies within BML Healthcare Ltd, which Mrs Stevens modifies if necessary to suit the needs of the home. These are dated and currently under review. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 18 From discussion with the maintenance man, examination of records and information on the Regulation 26 notices all the required servicing of equipment was in order. A record was being kept of water temperatures, which ranged from 44oC to 50oC and it was advised that the recommended temperature at which water should be delivered is 43oC. Mrs Stevens stated that hot water outlets in bathrooms were regulated but she was seeking advice from a plumber about the delivery of water at the required temperature to safeguard residents, although they all had supervised baths or showers. Staff received the required fire instruction and this was confirmed in discussion with them and the training record. The traning programme illustrated that for six staff moving and handling training should have been updated in March 2005. Mrs Stevens said an update had been arranged for July 2005. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 2 COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 2 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 2 x x x x x x 3 1 Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Requirement The medicines policy must include details of adminstration by crushing. It must indicate that when medicines are crushed the GP has considered capacity to consent and directions are included on the label. If medicines are supplied in this way it must be recorded on the care plan and noted if given in food. (See Section 622 Royal Pharmacetical Guidelines.) To prevent scalding pre-set valves of a type unaffected by changes in water pressure and which have fail safe devices fitted locally to provide water close to 43oC must be provided. The home must be able to demonstrate that all care staff have current moving and handling certificates. Timescale for action 06.08.05 2. 38 13 06.08.05 3. 38 13 06.09.05 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 Good Practice Recommendations D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 21 Avonwood Manor 1. Standard 9 2. 3. 4. 5. 9 15 16/18 27 For medicines not in the MDS sytem such as blister packs, dating packs when they are started or entering a carry forward balance on the MAR chart would improve the audit trails. When staff write on the MAR chart a second competent person should check and sign to confirm that all details are correct. Where practical service users should be asked if they would like the alternative menu. Policies and procedures relating to complaints and vulnerable adults should be re-enforced in team meetings and supervision sessions. As well as service users numbers, dependency levels should also be used as an indicator to demonstrate if additional care staff are needed. Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF 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 Avonwood Manor D55 S43057 Avonwood Manor V215074 260505 Stage 4.doc Version 1.20 Page 23 - 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!