Care Home: Avalon Residential Home

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well Avalon provides a comfortable and homely environment for the people who live there. People spoken with and the feedback we also received in the surveys from people indicated that they are happy with the standard of care they receive. Following an assessment of needs prospective new people are written to, confirming if the home can meet their needs or not.Avalon Residential HomeDS0000068030.V377233.R01.S.docVersion 5.2Medicines were stored safely and were available in the home to administer to people in the way the doctors had prescribed. The majority of people said the food provision is good and they are offered alternatives to the each meal. Several people said they are able to go alone and undertake activities of their choosing which enables them to live a fulfilling life. What has improved since the last inspection? The requirements issued at the last inspection were followed up and all but one has been met, which is excellent. The home has reviewed parts of their medications systems to make sure people are not being placed at risk. This particularly relates to clear and accurate records being maintained of medication administered in the home and they have reviewed and updated the protocol they in had in place for `when required` medication. The manager has now applied to us to be considered for registration. What the care home could do better: Some people`s care plans require more specific details and people`s personal choices. The requirement issued at the last inspection for more specific details in care plans about the management of people`s diabetes remains outstanding. We have made some recommendations to assist the home in improving their medication system. We identified several issues with the environment that would need to be addressed. Key inspection report CARE HOMES FOR OLDER PEOPLE Avalon Residential Home 17 Barnwood Road Gloucester Glos GL2 0RZ Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 19th August 2009 09:55 DS0000068030.V377233.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 2 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 Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avalon Residential Home Address 17 Barnwood Road Gloucester Glos GL2 0RZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01452 417400 ARTI Services Ltd The Manager is in the process of being considered for registration. Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th August 2008 Brief Description of the Service: Avalon is a detached Edwardian property situated on the corner of a residential road and the main Barnwood Road into Gloucester City. The House has been extended to offer personal care for fourteen older people. All bedrooms are for single use, although there is one bedroom that would be large enough to accommodate a couple, if this was required. All bedrooms are en-suite. On the ground floor there is a sitting room, dining room and small sun lounge. Access to the first floor is via a main staircase that has been fitted with a chair lift. There is a small rear garden with an enclosed patio area with chairs and sun shades for use in the summer. There is also a small car park to the rear. The Statement of Purpose and Service User Guide are displayed in the hallway and people can request to see a copy of our latest inspection report. The fee ranges per week are from £400 to £450. Extras not included in the fees include chiropody and hairdressing. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out by one inspector on one day in August 2009. Before we visited the home we sent surveys to the home in order to obtain the views of people who use the service and staff. We received two back from people who use the service and five from staff. The results of these have been used in the report. We requested an Annual Quality Assurance Assessment (AQAA) prior to this inspection. We received it on time and it contained detailed information about how the home feels they are meeting the needs of people who use the service and any plans for areas they wish to improve over the next 12 months. The AQAA also contains Dataset which is numerical information. We looked at other information we have received from or about the service from other stakeholders. This includes where the home notifies us of any incidents that affects the well being of people who use the service. We looked at a number of systems the service has in place to include care records, activities, food provision, staff supervision and training, complaints, medication and maintenance records. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Avalon provides a comfortable and homely environment for the people who live there. People spoken with and the feedback we also received in the surveys from people indicated that they are happy with the standard of care they receive. Following an assessment of needs prospective new people are written to, confirming if the home can meet their needs or not. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 6 Medicines were stored safely and were available in the home to administer to people in the way the doctors had prescribed. The majority of people said the food provision is good and they are offered alternatives to the each meal. Several people said they are able to go alone and undertake activities of their choosing which enables them to live a fulfilling life. What has improved since the last inspection? 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. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A full assessment of any people who may use the service is undertaken prior to admission, so that the home is able to provide assurances that their needs can be met. EVIDENCE: The home has on display a copy of their Statement of Purpose and Service Users Guide. We examined a pre admission assessment of a person who had recently been admitted to the home. The assessment was completed by the manager and prior to this person’s admission. The home has a set format in place and this contained details of the person’s assessed needs, list of their medications and information about the person’s close personal relationships. This person was Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 9 funded by the local Community and Adult Care Directorate (CACD) and a copy was available of the assessment completed by the Social Worker. The AQAA states that any proposed admissions are discussed as a staff group prior to any decision being made by the home. The AQAA also states that the home is planning to look at other ways of providing prospective people with more information about the service using for example video, photographs, re designed newsletter format and improved leaflets. We spoke to this person but they were unable to remember if they had visited the home prior to admission but the manager said they do encourage this where able or a representative visits on their behalf. This person did say they were very happy at the home. They also had a copy of the home’s Service Users Guide in their room. We asked people in the surveys we sent them, did you receive enough information to help you decide if this home was the right place for you, before you moved in; both people said ‘yes’. Standard 6 does not apply to Avalon as they do not provide intermediate care. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and choices. The principles of respect, privacy and dignity are put into practice by all staff. EVIDENCE: On the day of the inspection 10 people were living at the home and one person was admitted to hospital due to illness. We examined the care of one person in detail, and this includes examining care records, speaking to the person if able, speaking to staff and observing interaction between staff and this person. We also looked at a number of other peoples care records. This person had a detailed assessment of needs in place that is incorporated into the care plans. The format used by the home contains vast amounts of details about each person and mostly includes their choices. We saw ongoing reviews and people were included in these as they have been signing their Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 11 care plans. We also saw they are able to put in any comments, which is excellent practice. Care plans were in place for all assessed needs, however some of the care plans would benefit for more specific details for example where it mentions prompting and encourage independence it would be better to document what the person is able to do for themselves. The person who had their care examined in detail had a care plan in place for diabetes but again it lacked specific details about what exactly the staff need to observe for and the signs and symptoms of when external medical care would be required. The staff should not use words like ‘regularly’ as more specific information is needed. This person was assessed as being nutritionally at risk but again the care plan lacked detailed personalised information about how this need should be managed; for example the care plan states ‘staff to report if not eating very well’. This care plan must be re-written. We could not find any evidence of this person being weighed, however it mentioned in the care plan review that they had put on weight. On checking other peoples care records their weights were being recorded. The manager said she would look into why they had not been recorded. Within the care planning format the home has included some of the principles of the Mental Capacity Act 2005 in relation to specific areas for example, peoples’ ability to consent for medical treatment. The care records that we examined in detail for one person had an assessment undertaken by a Community Psychiatric Nurse (CPN) and the home had they reviewed this assessment. This is good practice. We also saw evidence that people were asked about their medication especially at night time in relation to what time they would to receive it. We discussed the care of another person in detail and how the home should look at care planning and risk assessment for a particular need. Risk assessments were in place for falls, moving and handling and other risk assessments that had been designed by the home. These included an independent living risk which is handwritten and looks at the environment and each person’s specific needs, which is good practice. Ongoing reviews were seen of these. Staff spoken with about the care of the person who had their care examined in detail demonstrated good knowledge of their care needs. Staff maintain ongoing records for each person and records of any external professionals visits are also recorded. We saw evidence that people have access to these professionals and some people spoken with confirmed this. These include GP’s, Community nurses, CPN’s, and Chiropodists. One person was attending a hospital appointment with their family during the inspection. We spoke to a number of people who confirmed they are happy with the standard of care they receive from the home. We asked people in the surveys we sent them, do you receive the care and support you need, both people said ‘always’. We also asked does the home make sure you get the medical care you need, only one person answered this question and they said ‘always’. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 12 We observed during the inspection that the staff had contacted two peoples’ GP’s, as one person was admitted to hospital and another person told us about their GP visit. We examined the system the home has in place to manage people’s medications. The manager said that one person was able to self medicate some of their medications and a plan was in place for this. The home has recently had its homely remedies policy reviewed by a pharmacist and all peoples GP’s have agreed to the list of medications for each person they see. Records were in place for medication received into the home, administered and where required returned the pharmacy. All Medication Administration Records (MAR) were examined and no gaps were found in the recording of medications administered. Each person has a front sheet that has their name, a photograph and any allergies recorded. Handwritten entries had been signed by a second member of staff to help to minimise any errors. Care plans were in place for any medications prescribed as ‘prn’ or as required, however some needed to say where a cream was to be applied and care plans for any pain relief would need to contain more details about when it is to be used and if the person is able to request it. The staff use trolleys to transport the medication around the home and to store the medication when it is not in use. The home must be able to demonstrate that all medication including stock medication is stored at the manufactures recommended temperature. Dates of opening were seen on boxed medication and creams. It is recommended that creams are stored on a separate shelf to other medication in the trolleys once opened. The home has several people that are having medications that need to be stored a controlled medication. Records were checked of these and they were all correct. The home needs to consider auditing of this medication and we would recommend weekly documented checks. An initials and signature list is in place for staff that administer medications. A number of staff training records were seen in relation to medication training. For staff that undertook medication training prior and up to 2007 they should now have access to a medication update course. We observed staff interacting with people during the inspection and they knocked on peoples doors prior to entering their bedrooms and spoke to people in a respectful manner. People we spoke with said they did not have any concerns about how the staff treated them and they felt the staff maintained their privacy and dignity. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their daily lives and where requested the home will provide activities to meet peoples individual expectations. EVIDENCE: Activities are undertaken by care staff and these can take place weekly or more often depending on people who use the service. Examples of activities that have taken place include cake making, playing cards, arts and crafts. Staff said they have asked people about outings but people have declined. One person likes to play cards with staff. Some people spoken with said they prefer to make their own activities and not join in the ones provided by the home. One person said their hairdresser visits them every week. No external entertainers are provided except at Christmas. In relation to peoples spiritualist needs the manager said that at the moment people have declined any communion or to be taken to a local Church. Information about peoples spiritualist needs is recorded in their care records. Several people said they are Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 14 able to go out alone and undertake activities in the local community and other people are able to go out with families. The AQAA states that as part of the dementia link workers group the home is looking to pilot a ‘pen pal’ system where people in care homes write to people in the local community. They hope to start this shortly. Meetings for people to discuss the running of the home and request menus changes etc take place and we examined minutes of the last meeting. In the surveys we sent people we asked them, does the home arrange activities that you can take part in if you want, only one person answered this question and they said ‘always’. Visiting to the home is not restricted and visitors are able to have meals with their relative/friend if they so wish. The AQAA states that they are looking to encourage this to maintain social contact for people who use the service. A number of bedrooms belonging to people were viewed with their consent and people had their personal belongings on display. People said they are able to choose what they do each day and this includes what time they get up and go to bed. One person said they still manage their own financial affairs. Information about a number of external services is provided for people in the home and this includes Lasting Power of Attorney and Mental Capacity Act 2005. The staff said that the home operates a 4 week menu rotation and they are planning to review the menu shortly. People are able to have input into the menus at their meetings. People are able to request a cooked breakfast. People did not know what was for lunch on the day of the inspection as the menu board in the dining room had not been updated, however the staff are aware of peoples likes and dislikes. Two people were observed to have alternatives. Staff offer people drinks and offer any assistance discreetly. A number of people choose to have their meals in their bedrooms and these are taken to people covered on a tray. The majority of people said they enjoy the food provided by the home. We also asked people in the surveys we sent them do you like the meals at the home and both people said ‘yes’. The home was recently inspected by the local Environmental Health Department and they were issued with a 4 star rating. We saw a copy of the report of this visit. Health and safety checks were taking place but the cleaning schedules were not up to date, however from speaking to a member of staff they were aware of what cleaning needs to be undertaken. Food records are also maintained. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express any concerns they might have and have access to a formal complaints procedure. Systems are in place to help safeguard people from harm or abuse. EVIDENCE: A copy of the homes complaints procedure is on display on the notice board on the ground floor. A suggestion/comments box is by the visitors signing in book. The manager said that following a recent quality assurance exercise where people who use the service were sent a questionnaire, people said they were unsure about the complaints policy. Since then all people have been issued with a copy of this policy. The Registered Provider said that they have received one complaint that was investigated and the complainant was happy with the homes response. Our contact details require updating with our Newcastle address and contact telephone number on the homes complaints policy. We asked people in the surveys we sent them, is there someone you can speak to informally if you are not happy, both people said ‘yes’. We also asked do you know how to make a formal complaint and both people said ‘yes’. People we spoke with during the inspection said they had no complaints and were happy with the care they receive. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 16 We asked staff in the surveys we sent to them, do you know what to do if someone has concerns about the home and all five staff said ‘yes’. The majority of staff have undertaken the local County Council’s safeguarding training called the ‘Alerters Guide’ and the manager said they are planning to send all new staff on this training. The homes AQAA states that all policies and procedures relating to safeguarding people were reviewed this year and staff have access to these. Training on managing challenging behaviour has been provided by the local Care Home Support team. No people who use or used the service in the last 12 months have been referred to the local County Councils Adult Protection unit. All staff have a POVA (Protection of Vulnerable Adults) check before starting at the home and a Criminal Records Bureau Disclosure (CRB). The manager said that no staff have been referred to the POVA list. The manager has undertaken training provided by the local County Council in relation to the Mental Capacity Act 2005 and Deprivation of Liberty. The home has plans to send all care staff on this training. The home has incorporated some of the principles of the Mental Capacity Act into their care planning, which is good practice. The manager said she is aware of the local contact for obtaining advice regarding Deprivation of Liberties as she has already obtained advice from them. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of this home is not a purpose built, however people live in a comfortable and pleasant environment. EVIDENCE: Avalon residential home is not a purpose care home, however aids are provided to assist people, and these include a stair lift and bath hoist. As part of the inspection process, we toured the home. We were invited into some people’s bedrooms and had the opportunity to talk to them about the facilities they are provided with. People said they were happy with their bedrooms and they confirmed that they had everything they needed. Some people had their own small items of Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 18 furniture and personal photographs, pictures and ornaments of their choosing on display. The AQAA states that a number of new carpets have been fitted into people’s bedrooms since the last inspection. During the tour of the home we found some areas that need attention and these include; 1. The window in dining room is distorted and people are not able to look out into the garden area. The Registered Provider said that they need to look at changing the window pane. 2. The carpet in the hallway at the rear of the property has a damaged area that could place people at risk of tripping and must be replaced. The Registered Provider said they are looking to put down some alternative flooring. 3. Bedroom 6 the chest of draws is broken and needs to be replaced. The Registered Provider said they were aware of this and have plans to replace them. 4. The flooring in the kitchen has a damaged area that must be renewed and a bin with a lid is required as this is an infection control risk. Some of the work surfaces in the kitchen are looking worn and a plan needs to be devised about when these will be replaced. 5. Two of the bedrooms on the upper floor were odorous however carpet cleaning was taking place during the inspection. The home has a conservatory where people can sit and look at the garden area, however it was very cluttered. The lounge does not contain enough chairs for all the people that live in the home; however some people spoken with said most people tend to stay in their bedrooms and that not all people use this room at the same time. Due to the size of the home the dining room is used by the manager and staff for completing paper work as the manager has an office on the top floor. Where possible we would suggest that staff do not use people’s communal space for the running of the home. There are a number of areas for people to sit outside in the warm weather and people said how much they enjoy doing that. The Registered Provider said they are looking to fit a ‘wet room’ in the downstairs bathroom as at the present time they have an upstairs shower room but it has a step into the shower and the room is very small. People spoken with said they were happy with the cleanliness of the home and their bedrooms. We also asked people in the survey we sent them, is the home fresh and clean and both people said ‘always’. The home is in the process of appointing a new domestic and the staff are undertaking the domestic duties at the present time whilst this takes place. We viewed the laundry area and the home has a system for managing soiled linen. People we spoke with said they were happy with the laundry and one person said their clothes are ironed to perfection. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 19 Air freshner self devices are situated around Avalon. The home has a waste contract in place to dispose of continence products. Staff are supplied with protective equipement such as gloves and aprons and we observed staff using them when required. The AQAA states that the home has an infection control procedure in place that was reviewed this year and that 10 staff have undertaken training in this area. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to meet the needs of people who use the service. EVIDENCE: The manager confirmed that the home is currently fully staffed. Staff members we spoke with and the manager confirmed that there is sufficient staff on duty to meet the needs of the people living there. Staff spoken with said the staff work well as a team. In the survey we sent to staff we asked them, are there enough staff to meet the individual needs of all people who use the service and all five staff said ‘always’. Comments we received in the surveys include “At Avalon we promote independence and well being very well” and “The home continually updates our training and provides ongoing support to enable us to provide the best quality of care for our residents”. Other comments include “we need more support from the proprietors and appreciation and the right equipment” and “we are not allowed our certificates of courses and qualifications that we have done and we get a photocopy and we are asked by the management why we want to know”. The manager said that the home does not use agency staff as their own staff will cover any vacancies on the duty rota. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 21 People spoken with at the inspection all praised the staff saying they are very good and helpful. In the surveys we sent to people who use the service we asked them, are the staff available when you need them, both people said ‘always’. We also asked do the staff listen to you and act on what you say, both people said ‘always’. Comments we received include, “very comfortable at the home” and “look after me well”. The manager said that 83 of staff have an NVQ 2 or above in health and social care which is excellent. As part of the inspection process, the recruitment records of three staff were examined. Records demonstrate that staff have been recruited and inducted properly. Any gaps in employment history are explored and recorded. All three staff had records in place as evidence that POVA check had been completed prior to them starting work and a full Criminal Records Bureau Disclosure (CRB) had been applied for. And in the case of one member of staff their CRB had been returned prior to them starting work at the home, which is good practice. The manager provided us with evidence that new staff members undertake an induction course. Part of this is pertinent to the home and other part is based on the Skills for Care common induction standards. The manager is the mentor for new staff and other staff also assist with shadowing new staff. Evidence shows that staff attend mandatory training such as moving and handling, fire awareness, abuse awareness, first aid, basic food hygiene and health and safety. The manager said that the staff have undertaken a number of course with the Care Home Support Team to include falls, malnutrition and dehydration and care planning. The manager was also able to show us evidence that they have enrolled with a local provider for training in meeting people’s needs, equality and diversity and accountability. First aid training was due to take place the day after the inspection and food hygiene in September. Staff spoken with and in their surveys confirmed they have access to ongoing training. The home keeps ongoing records for each member of staff for any training they have undertaken. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of this home is undertaken by a competent manager who runs the home in the best interests of the people who use the service. EVIDENCE: The manager is in the process of being considered for registration by us. She has been working at the home for nearly 3 years now. We had to write a warning letter to the Registered Provider to make sure the manager had applied to us to be considered for registration as she has been in the position of manager for several years. The manager confirmed that she has completed Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 23 her NVQ level 4 and her Registered Managers Award (RMA) and undertakes other training relevant to her job role. People and staff said they found the manager approachable. The Registered Provider is in the process of undertaking the leadership and management course. The manager is pregnant and will be leaving to go on to maternity leave in the near future and the Registered Provider must inform us in writing of the alternative management arrangements that will be put in place. Meetings for people who use the service take place every 2-3 months. Minutes of these demonstrate that the views of the people living at the home are sought and listened to. The home securely holds personal money for some of the people living at the home. We randomly selected three people’s monies and records to check. We found that two of these were all correct. The third one the records did not tally with the amount of money. The manager was going to investigate this. We would suggest that these are audited at least monthly. Questionnaires have been sent out to the people using the service and their relatives in May this year. The returned surveys were sampled. The manager had collated the results and from this they had addressed any areas of concern. We saw evidence that some auditing is also taking place. The manager completed an infection control audit and they now have alcohol hand gel in place. The home sent us their Annual Quality Assurance Assessment (AQAA) on time. It contained details about how the home is meeting people’s needs and what has improved in the last 12 months and plans for further improvement in the next 12 months. The Dataset part of the AQAA which is numerical information was also completed in full. The manager has undertaken training in Mental Capacity Act 2005 and Deprivation of Liberty and the home has plans to send all care staff on this training. Plans are in place to also provide staff with training on equality and diversity. Staff members told us that they have the opportunity to attend regular team meetings and one was taking place during the inspection. Records for supervision sessions were examined for randomly selected members of staff. The most sessions staff had received were two which would mean the home is not on course to meet the recommended six times per year. The manager said she has informal chats with the staff and we would recommend that some of these are recorded to demonstrate what supervision is taking place. Supervision records did show that care practices, training and personal development is discussed within the meetings. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 24 Records relating to health and safety checks were examined and found to be in order. A check was completed on small portable electrical appliances on May this year. The manager confirmed that the home has a contract with a gas service company, who complete regular checks at the home. Regular audits of accidents take place and preventative measures are identified as a result of the audit. The home has a detailed fire risk assessment. Regular checks on fire fighting equipment takes place and staff regularly receive fire instruction. Window restrictors are on all upstairs rooms. The manager said that the home has recently had a visit from Environmental Health Department (EHO) in relation to health and safety and said the window restrictors they in place are safe. The home has a current environmental risk assessment in place and this was reviewed in June this year. The home has a policy in place for swine flu and three staff member contracted this, however the home did not notify us as required under Regulation 37 of the Care Home Regulations 2001. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 2 X 3 Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? yes 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 OP7 Regulation 15 (1) Requirement Care plans must include sufficient information on the management of specific conditions such as diabetes. This requirement has been partially met since the last inspection. Timescale for action 15/10/09 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. 2. 3. Refer to Standard OP9 OP9 OP9 Good Practice Recommendations Staff that have undertaken medication training prior and up to 2007 should now have a refresher course. Auditing of medications stored in the controlled drugs cabinet should be undertaken weekly and records maintained of this. Care plans for ‘prn’ medications should contain more information about their use and if the person is able to request it themselves. DS0000068030.V377233.R01.S.doc Version 5.2 Page 27 Avalon Residential Home 4. OP9 5. OP9 When people are prescribed pain relief the exact time of administration should be recorded to make sure the manufacturers recommended timescale for administration is followed. The home needs to monitor the temperature of both trolleys and the medications storage cupboards to make sure medication is stored at the manufactures recommended temperature. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 28 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Avalon Residential Home DS0000068030.V377233.R01.S.doc Version 5.2 Page 29 - 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!