Key inspection report
Care homes for older people
Name: Address: Avonwood Manor 31-33 Nelson Road Branksome Poole Dorset BH12 1ES The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Gloria Ashwell
Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 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: Avonwood Manor Ltd care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: 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 are above the age of 65 and have a mental disorder or dementia. Avonwood Manor is owned by Avonwood Manor Ltd, and the home is managed through Affinity Care Homes Ltd. The home is in a quiet residential area close to the shops and amenities of Westbourne. The home comprises two large properties joined together by an extension. Each of the properties has three floors and there is a passenger lift at both ends of the home. Communal areas are on the ground floor and there are well maintained and enclosed gardens accessible to residents, at the back of the home. Care Homes for Older People Page 4 of 26 1 8 0 6 2 0 0 9 0 0 Over 65 49 49 Brief description of the care home Most bedrooms are for single occupancy with en-suite hygiene facilities. There are 8 bedrooms for shared occupancy. Car parking spaces are at the front of the home for use by staff and visitors. At the time of this inspection weekly fees ranged between £450 and £750 per person; up to date information on fees can be obtained from the home. Care Homes for Older People Page 5 of 26 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a statutory inspection required in accordance with the Care Standards Act 2000. This inspection was carried out by two inspectors, and throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. This inspection was unannounced; the inspectors arrived at 10:00 on 8 December 2009, together with the manager they discussed and examined documents regarding care provision and management of the home, and alone toured the premises and spoke to residents, staff, observed staff interaction with residents and the carrying out of routine tasks. Care Homes for Older People
Page 6 of 26 During the inspection, particular residents were case tracked; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same residents were examined and the residents spoken with. The inspection included the carrying out of a Short Observational Framework for Inspection (SOFI), because people with dementia and/or complex needs and ways of communicating are not always able to reliably tell us about their experiences, we use this formal way to observe people and to help us understand their experience of life in the home. We observed up to five people for two hours and recorded their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. During this inspection compliance with all key standards of the National Minimum Standards was assessed. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? The previous key inspection took place on 18 June 2009 and determined the outcome rating to be poor. With specific regard to medicine handling random inspections were carried out on 21 September 2009 and 12 November 2009. To monitor the general standard of the home a random inspection took place on 20 October 2009 and found that although some improvements had been made, the overall standard of the home, and in particular of life experienced by many residents, remained poor. Since then the provider organisation has demonstrated a strong commitment to properly raise the standard of this home. Accordingly, the temporary manager has been installed to manage the home on a daily basis and has quickly made many important improvements designed to raise the quality of life of people living in the home. Care Homes for Older People
Page 8 of 26 There is an ongoing and thorough process of assessment and audit of all aspects of the home, to effectively monitor standards and as necessary, to promptly carry out improvements. In particular, the standards of care planning, care provision and medicine handling have been significantly improved and effective staff leadership, staff training and supervision have increased the morale and competencies of staff, with particular regard to their understanding of the needs of people with dementia. This has resulted in a much higher quality of life being experienced by residents, with greater opportunities for personal choice and enjoyment of daily activities, including mealtimes and recreational and social pursuits. What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them. Evidence: Individual care records are kept for each resident the records of a resident admitted since the last inspection were examined and showed that, prior to moving to the home, care needs had been fully assessed to identify any potential risks, such as a history of falls, and the steps needed to minimise them on admission. Wherever possible details of the prospective residents usual routine over a 24 hour period are recorded, including for example when they choose to go to bed, what they prefer to wear in bed, when they like to get up, their favourite meals etc. This information will help the resident settle into the care home more easily on admission. Prospective residents or their representatives on their behalf are invited to provide information about their life story, family background and social preferences. The full
Care Homes for Older People Page 11 of 26 Evidence: care plan is developed from the findings of the various assessments. Prospective residents and their relatives or representatives are invited to visit the home, to look around, perhaps enjoy a meal, meet with the manager, staff and other residents and ask any questions before making a decision about whether or not to move in. Copies of the Statement of Purpose and Service User Guide are provided to each resident and their relatives or representative. Following the pre admission assessment, a letter of confirmation is written to assure the prospective resident (or their relatives or representative) that the home can meet their needs. Care Homes for Older People Page 12 of 26 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and social care needs of residents are met by suitably trained staff; doctors and other professionals visit as necessary and residents receive the medicines they have been prescribed. The standard of care is in accordance with each persons individual needs. Evidence: We combined the information we obtained from the documents we read, with the things we saw taking place in the home during our inspection, and what we were told by staff and visitors. This provided evidence that the frequently complex and changing needs of residents are properly managed by caring staff who combine meeting the physical needs of people with consideration for their individuality and emotional and social needs. The care records of 4 people who live at the home were examined and found to contain risk assessments forming the basis for care plans and daily records describing the care of each person.
Care Homes for Older People Page 13 of 26 Evidence: For some people who are known to be at risk of accidental falling, alarm mats are used to alert staff when they get out of bed at night. The potential risks associated with the mats have been assessed, the care plans refer to the use of the mats and the consent of the resident or their representative has been obtained to the use of the alarm mat. Medicine handling is carried out by staff trained in this work. Medication records were properly kept indicating that residents receive prescribed medicines at the correct times and in correct amounts. We watched them give medicines to residents at lunchtime and saw that system was safe; staff followed procedures but managed to give everyone the time and individual attention they needed. The information about medicines and medicine audits was good. Residents and visitors spoken with during the inspection said that residents are treated with respect and their privacy and dignity is protected at all times. Care Homes for Older People Page 14 of 26 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to engage in social and recreational activities and are encouraged and supported to pass the time according to individual preference. A choice of menu is provided and meals are nutritional and appetising. Evidence: There is a weekly programme of recreational and social activities including handicrafts, exercises to music, one to one and small group activities in addition to seasonal events and celebrations. During the inspection we saw many examples of good interactions between staff and residents, including conversations about articles in the newspapers which are now delivered daily to the home and distributed in lounge areas. Residents were also involved in conversations about Christmas, and were seen handling the decorations which were shown to them by staff. These and similar interactions demonstrated that staff have a good understanding of the importance of such things, and that engaging residents in everyday matters is appropriate and can significantly improve their enjoyment of life in the home. Visitors are welcome at any time and those spoken to during the inspection said they are always made to feel welcome and placed at ease by the staff. Meals provide good nutrition and are liked by residents. Most residents
Care Homes for Older People Page 15 of 26 Evidence: take meals in the dining rooms on the ground floor and others receive them in their bedrooms. Residents we spoke to said they are always offered a choice of meals and the food is appetizing and plentiful. We observed the serving of lunch during our inspection and saw that residents were offered a choice of meals and those who required assistance with eating were given help in a sensitive and careful manner. Care Homes for Older People Page 16 of 26 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain and are confident their complaints would be listened to. Residents are safeguarded against risks of abuse in its various forms. Evidence: The home has a complaints policy and procedure. From discussion with the registered manager and examination of records there was evidence that there is a reliable process ensuring that any complaints received would be competently managed to ensure that if weaknesses in service were identified they would be unlikely to recur. All staff receive training on the safeguarding of vulnerable persons and the home has a written policy and procedure for the protection of vulnerable adults. Care Homes for Older People Page 17 of 26 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable, clean, well equipped and suited to the needs of residents. Evidence: The home is well maintained both inside and out. The garden is attractive and well laid out, with only safe areas accessible to residents. Recent auditing has identified the need for some refurbishment and redecoration and this will be prioritised within the continuous programme of repair and renewal designed to ensure the premises and furnishings remain comfortable, well maintained and safe. The building complies with the requirements of the local fire service and environmental health department. At the time of this inspection all areas of the home were clean and there were no unpleasant odours. There are bathrooms equipped for the use of persons requiring assistance. The laundry room is equipped with equipment compliant with hygiene requirements, including a sluice cycle washing machine. Care Homes for Older People Page 18 of 26 Evidence: Supplies of clean linen were seen to be available. Care Homes for Older People Page 19 of 26 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and maintenance of the good condition of the premises. Staff receive training for their work and in particular, training in dementia care is provided, to ensure their understanding of this essential aspect. Evidence: Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. All staff spoken with during the inspection were enthusiastic about their work and felt that they provided a good standard of care to residents and are properly supported by the management and training provision. The records of two recently employed staff members were examined and found to contain all essential information including written references and evidence of identity. Criminal Records Bureau (CRB) disclosures are obtained for all staff in advance of employment. There is a comprehensive induction process for all staff, designed to ensure their familiarity with all aspects of the home and a clear understanding of their responsibilities. All staff undertake and as necessary update training in core subjects including
Care Homes for Older People Page 20 of 26 Evidence: dementia care, fire safety, moving and handling, food hygiene and emergency aid. The recently employed staff had received induction training and from talking to staff and examining records there was evidence that they are encouraged and supported to undertake training in subjects relevant to their work. Care Homes for Older People Page 21 of 26 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is properly managed and maintained to promote the safety and well being of service users. Evidence: Since the last inspection Mr Iain Slack has become the temporary manager of the home. He had previously been working for the provider organisation as a Regional Manager and is suitably experienced in care home management. Mr Slack is liked and respected by staff and is familiar with each resident and their needs and circumstances. The home has extensive systems for quality assurance; there are reliable processes of audit and monitoring of all aspects, including care practice and record keeping, medicine handling, staff training, administrative and household aspects. There is a selection of clear and appropriate policy and procedure documents, ensuring that staff have available the necessary guidance and instruction. The home does not manage the personal finances of residents; there are facilities for the temporary storage of monies and valuables which residents may no longer wish to
Care Homes for Older People Page 22 of 26 Evidence: personally hold. Staff trained in First Aid and health care are on duty in the home at all times. There are good processes for staff recruitment, induction and formal supervision. Records are kept of all accidents and there is subsequent review of the care plan and periodic audit to identify any trends e.g. time, place, person, activity. Records indicated that fire safety equipment is routinely checked and tested at the required frequencies and during the inspection a sample of records regarding equipment servicing and maintenance were examined and found to be in good order. There is a written assessment of the Health & Safety of the premises and working practices designed to ensure the continued safety of all who live in, work and visit the home. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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, Care Homes 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 Care Homes for Older People Page 25 of 26 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 26 of 26 - 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!
