Care Home: Avarest

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What the care home does well Avarest presented as a well maintained environment and the people using the service confirmed they received appropriate levels of care and support. For example, comments received included: "All [management and staff] are kind, considerate and caring people and very pleasant"; "Good care. They [management and staff] keep me very happy" and "The staff have always looked after me very well". A relative also stated "I am satisfied with my mother`s care at Avarest." Systems had been established to assess the needs of prospective residents and care plans had been developed in consultation with the people using the service. Examination of medical records and discussion with residents confirmed people had access to health care practitioners subject to individual need. Residents were observed to receive visits from family members and friends during the day and the people using the service confirmed they were able to follow their preferred routines and reported that Avarest was a relaxed and pleasant home in which to live. The menu provided evidence that residents received a wholesome and nutritious diet and additional refreshments were served throughout the day. Residents spoke highly of the standard of catering and comments included "The food is very nice" and "We have a choice of food and it is always well prepared." Policies and procedures had been established to ensure an appropriate response to complaints and suspicion or evidence of abuse. Likewise, systems were in place to monitor the quality of the service provided to ensure the service was run in the best interest of residents. Staff continued to have access to a range of training including induction, safe working practice and national vocational qualifications. Support was also available to staff via formal supervisions. One member of staff reported "The management really look after the staff well with courses offered and training updated all the time. They are really nice to work for and with." What has improved since the last inspection? Since the last visit the owner / manager had updated home`s menu plan for residents to view so that people had information on breakfast and tea-time meals. Daily temperature records had also been maintained for the fridge used to contain medication. The home had continued to receive ongoing investment in order to improve the environment for residents. For example, in the last 12 months new carpets had been fitted in the communal areas and hall, stairs and landing and four bedrooms had been refurbished. Furthermore, a new tracking hoist had been fitted in the lounge and first floor bathroom and new patio doors had been renewed for three downstairs bedrooms. A new central heating boiler had also been installed and a new fridge and freezer had been purchased the kitchen. What the care home could do better: The `Resident Assessment Prior to Admission` form should be updated to include all the criteria outlined in Standard 3 of the national minimum standards to ensure an holistic assessment of needs is undertaken prior to admission. The administration of individual prescribed creams must be recorded on a Medication Administration Record. This will help to provide a clear audit trail and evidence that the creams have been correctly administered. Care plans should be updated to include a section on aims / objectives and outline how the routine health care needs of the people using the service are to be met. Care plans should also describe in more detail the support required by staff in response to each resident`s personal, health and social care needs. This will provide staff with more detailed instructions on how to meet the needs of the people using the service. Medication risk assessments / disclaimers should be updated to specify the name of medication / inhalers and the dosage. This will help to provide evidence that individual residents fully understand the details of any medication they wish to administer. The range and frequency of in-house and social activities should be reviewed to ensure the social and recreational needs of all residents are met. A copy of the most recent fire officer`s report should be located and available for inspection for reference. Staff must not commence employment at Avarest until two satisfactory written references and a Protection of Vulnerable Adults or Criminal Record Bureau check has been received. This will help to safeguard the welfare of the people using the service. The training programme should be extended to include other training relevant to the care of older people including equality and diversity and dementia. Detailed records of financial transactions should be maintained for any money handled on behalf of the people using the service to ensure best practice and a clear audit trail. The fire extinguishers should be visually inspected on a monthly basis and records maintained to ensure safe working practices. Key inspection report Care homes for older people Name: Address: Avarest 35 Chambres Road Southport Merseyside PR8 6JG     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: Daniel Hamilton     Date: 2 8 0 7 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 30 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 30 Information about the care home Name of care home: Address: Avarest 35 Chambres Road Southport Merseyside PR8 6JG 01704544646 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Patricia Wright,Mr Keith Wright care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 15 Date of last inspection Brief description of the care home Avarest is a residential care home providing accommodation for up to fifteen older people. The home is situated in a quiet residential area not too far from the centre of Southport and all its amenities and is within easy reach of public transport. The home is a large detached 3-storey building with 14 single bedrooms and 1 double room. There is a large, well-kept garden to the rear of the property and a small sitting area at the front. The communal areas in the home consist of a dining room and a lounge. Toileting and bathing facilities are located throughout. The home is well maintained internally and externally with good quality furniture and fittings. There is a passenger lift servicing all floors and a call bell system is fitted in the home. Care Homes for Older People Page 4 of 30 0 Over 65 15 Brief description of the care home The Care Home Fee is £389.00 per week. Care Homes for Older People Page 5 of 30 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 the service experience good quality outcomes. This unannounced inspection took place over one day and lasted approximately 9 hours. A partial tour of the premises took place and observations were made. Two care files and a selection of staff and service records were examined and the owner / manager, 3 care staff, a volunteer, three relatives and seven residents were spoken with during the visit. Reference was also made to an annual quality assurance assessment (AQAA) which was completed by the owner / manager. This document enables a person to undertake a self-assessment on the service prior to an inspection and contains information on how the people living in Avarest are supported, together with numerical information on the service. Care Homes for Older People Page 6 of 30 Survey forms were distributed to a number of residents or their representatives prior to the inspection in order to obtain additional views and feedback about the service. All the core standards were reviewed and previous recommendations from the last inspection in August 2006 were reviewed. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Since the last visit the owner / manager had updated homes menu plan for residents to view so that people had information on breakfast and tea-time meals. Daily temperature records had also been maintained for the fridge used to contain medication. The home had continued to receive ongoing investment in order to improve the environment for residents. For example, in the last 12 months new carpets had been fitted in the communal areas and hall, stairs and landing and four bedrooms had been refurbished. Furthermore, a new tracking hoist had been fitted in the lounge and first floor bathroom and new patio doors had been renewed for three downstairs bedrooms. A new central heating boiler had also been installed and a new fridge and freezer had been purchased the kitchen. Care Homes for Older People Page 8 of 30 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 30 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 30 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. People are given information and have their needs assessed before deciding whether to move into Avarest. This enables the service to identify needs and to determine whether care needs can be met. Evidence: A Statement of Purpose, Service User Guide and Contract had been developed in a standard format to provide information on Avarest for prospective and current residents and their representatives. The documents viewed were dated May 2003 and were in need of review as the name and contact details of the current regulator (The Care Quality Commission) had only been included in the contract. The owner / manager was advised to display an up-to-date copy of the Statement of Purpose and Service User Guide in the reception area of Avarest for people to view. Feedback received from residents and their representatives via surveys and through Care Homes for Older People Page 11 of 30 Evidence: discussion confirmed people had received information on the service and a contract / statement of terms and conditions before deciding whether to move into Avarest. Information received from the owner / manager prior to the inspection in the form of an Annual Quality Assurance Assessment confirmed policies and procedures were in place for referral and admission as previously noted. Two of the residents personal files were viewed during the visit. One file was for a resident who had recently moved into Avarest and the other was for a resident who had lived in Avarest for several years. Each file viewed was found to contain a Resident Assessment Prior to Admission form. Assessments viewed contained basic information on the needs of residents however information on weight, dietary preferences, social interests and hobbies, personal safety and risk and full details of prescribed medication had not been included. Some of this information had been recorded in personal profiles following admission and functional / dependency assessments had been completed to ensure assessment information was kept under review. Copies of social work assessments or care plans had been obtained for people referred via Care Management arrangement and information gained from the assessment process had been used by the home to devise a plan of care for each resident. Care Homes for Older People Page 12 of 30 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. People who live at Avarest are involved in the development of their care plans so they receive the care and support they need in the way they prefer. Evidence: The Annual Quality Assurance Assessment for the service confirmed that policies and procedures had been developed and reviewed covering Individual Planning and Review and the Control, Storage, Disposal, Recording and Administration of Medication as previously noted. Two of the residents personal files were viewed during the visit. One file was for a resident who had recently moved into Avarest and the other was for a resident who had lived in Avarest for several years. Each file contained a care plan, which outlined personal details, details of prescribed medication, care needs, general and mental health, mobility, personal care, continence, general and dietary care and special needs. Plans viewed had been kept under monthly review and had been signed by residents or their representatives. Care Homes for Older People Page 13 of 30 Evidence: The owner / manager was recommended to update the format of care plans to include a section on aims / objectives. Furthermore, the manager was advised to ensure that all care plans outline how the routine health care needs of the people using the service are to be met and describe in more detail the support required by staff in response to each residents personal, health and social care needs. A range of supporting documentation was also in place as previously noted. This included; daily report sheets, personal profiles, risk assessments and medical records. Separate records of personal care and weights were maintained for all residents. Advice was given to the owner / manager on how to improve the risk assessment format. Feedback received from residents and their representatives via care home survey forms and through discussion confirmed the people living in Avarest received the medical support they required. Health care records viewed detailed that residents had attended appointments with general practitioners, opticians, district nurses and chiropodists subject to individual need. Medication systems were checked with the owner / manager during the visit. The manager reported that there had been no changes to the medication policy since the last and a copy of new guidance issued by the Royal Pharmaceutical Society of Great Britain had been obtained for reference. It was recommended that a copy of the medication policy be placed in the medication file so that staff have easy access to the policy. A record of staff authorised to administer medication together with sample signatures and a system to check the identity of residents prior to administering medication remained in place as previously noted. Staff responsible for the administration of medication had recently completed refresher training entitled Drug Administration and systems had been established to ensure the competence of staff responsible for administering medication was kept under review. Medication checked was appropriately stored. Medication Administration Records (MAR) viewed had generally been completed to a satisfactory standard however some issues were noted. For example, in one instance the details of one form of medication had been recorded Care Homes for Older People Page 14 of 30 Evidence: on a MAR chart despite the medication having been discontinued. Furthermore, it was noted that prescribed creams had not been recorded on MAR and although a separate form was being used for prescribed creams, records did not provide a clear audit trail as the administration of individual creams had not been correctly recorded. Advice was also given regarding medication risk assessments as the details of the dose and name of inhalers had not been recorded. Staff spoken with during the visit demonstrated an awareness of the value base of social care. Feedback received from residents and relatives regarding the standard of care provided was good and residents spoken with confirmed their privacy was respected. Comments included: All [management and staff] are kind, considerate and caring people and very pleasant; Good care. They [management and staff] keep me very happy and The staff have always looked after me very well. A relative also stated I am satisfied with my mothers care at Avarest. Care Homes for Older People Page 15 of 30 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. People living at Averest generally receive the support they need to live their chosen lifestyles. Evidence: A weekly programme of activities had been developed which was displayed on a notice board for people to view. The programme for week commencing 27th to 31st July 2009 detailed the following activities. Hair / Beauty - Monday pm; ABC games - Tuesday pm; Bingo - Wednesday pm; Reminiscing - Thursday pm and Chair exercises Friday pm. Despite the programme being in place the record of activities for Avarest detailed that the last activity was Easy Exercises which was organised on the 12/06/09. A game of Snakes and Ladders was also coordinated on the day of the visit. A representative from a local Roman Catholic church continued to visit two residents in the home and another resident attended a local Pentecostal with friends. The owner / manager reported that she had consulted residents individually on their preferred activities however the level of interest to participate in activities remained low. A number of residents spoken with confirmed that they were not interested in Care Homes for Older People Page 16 of 30 Evidence: activities however three residents reported that they would like activities to be organised on a regular basis. This request should be actioned. Residents were observed to follow their preferred routines and receive visits from their family and friends throughout the day. The people living in the home reported that the environment remained relaxed and friendly. There were no set visiting times and residents were able to maintain contact with people of their own choice both inside and outside the home. The service continued to provide a range of meals based upon a four-week menu plan that offered a choice of wholesome and nutritious meals. The menus had been updated since the last inspection to include breakfast and tea-time meals and had been laminated and produced in a large print format. Records of individual meal choices had been recorded for dinner and tea-time meals. The owner / manager was advised to also record each residents dietary intake at breakfast time. Meals were served in the homes dining room, which was equipped with tablecloths, flowers and condiments. Additional drinks were served throughout the day and residents were able to eat their meals in their room if they wished. Lunch and tea-time sittings were discreetly observed and it was clear that residents considered mealtimes to be a social occasion. Care staff were observed to also be present during mealtimes to offer support for residents as required. Feedback received from residents on the standard of catering was generally positive. For example, comments included: The food is very nice and We have a choice of food and it is always well prepared. Care Homes for Older People Page 17 of 30 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. The people who live at Avarest understand how to complain and systems are in place to safeguard and protect vulnerable adults from abuse. Evidence: The Annual Quality Assurance (AQAA) for Avarest confirmed a policy and procedure on concerns and complaints had been developed for the service as noted at the last inspection. A copy of the policy was displayed in the hallway in the reception area and feedback received from residents and their representatives via surveys and discussion confirmed people knew how to complain and that staff listened and acted on concerns. No concerns were raised with the inspector during the inspection process. The AQAA detailed that there had been no complaints or safeguarding referrals in the last 12 months and this was verified by checking the complaint log for Avarest. Likewise, the Care Quality Commission had received no comments, complaints or allegations about the service in the past year. Policies and procedures were in place to provide guidance to staff and to ensure an appropriate response to suspicion or evidence of abuse. These included; a Guarding Against Abuse, Whistle blowing and the local authoritys Adult Protection Procedures. Discussion with staff and examination of training records confirmed staff had recently completed refresher training in adult protection via Sefton Council and the manager / Care Homes for Older People Page 18 of 30 Evidence: owner and staff spoken with demonstrated a sound awareness of their duty of care and the procedures to follow in order to safeguard vulnerable adults from abuse. Care Homes for Older People Page 19 of 30 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 environment is well maintained and this provides residents with an attractive, comfortable and homely place in which to live. Evidence: Avarest did not employ a handy person as the manager / owner lived on-site and was responsible for undertaking minor maintenance tasks including the upkeep of the gardens and ornamental fish pond. Contractors were also hired as and when required to attend to specialised maintenance work and the servicing of equipment. A health and safety book was in place for staff to record work in need of attention. A maintenance plan had not been developed for the renewal of the fabric and decoration of the home however a partial tour of the premises and examination of the Annual Quality Assurance Assessment (AQAA) for Avarest confirmed the premises had continued to receive investment since the last visit. In the last 12 months new carpets had been fitted in the communal areas and hall, stairs and landing and four bedrooms had been refurbished. Furthermore, a new tracking hoist had been fitted in the lounge and first floor bathroom and new patio doors had been renewed for three downstairs bedrooms. A new central heating boiler had also been installed and a new fridge and freezer had been purchased the kitchen. Care Homes for Older People Page 20 of 30 Evidence: Residents were observed to have access to personal mobility aids, subject to individual needs and rooms viewed had been personalised with personal possessions, pictures and other memorabilia. (Please refer to the Brief description of the Service section for more information on the premises). The service continued to employ one part-time domestic and areas viewed during the inspection appeared to be clean and hygienic. The AQAA detailed that policies and procedures were in place for Communicable Diseases and Infection Control and the Control of Substances Hazardous to Health and training records detailed that the majority of the staff team had completed training in infection control. The laundry was appropriately sited away from food preparation areas and equipped with two washers (one of which had a sluice wash), two driers and a hand washing sink. Individual baskets were available to store laundry for each resident and staff had access to protective clothing as previously noted. Records showed that an Environmental Health Officer had visited during January 2009 and no issues of concern had been noted. The fire log book also detailed that a representative from the fire department had visited during February 2009 however a copy of the report could not be located. Care Homes for Older People Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practice is not robust and does not adequately protect the welfare of residents. Evidence: Discussion with the owner / manager and examination of the staffing rota confirmed the arrangements for staffing remained the same as at the last inspection. A minimum of two care staff were on duty throughout the day. During the night, the home was staffed with one waking night staff and the owner / manager provided a sleep-in service. Details of the shifts / hours worked by the owner / manager had not been included on the rota. This should be addressed. Feedback from residents or their representatives via care home survey forms and through discussion confirmed the people living in the home received the care and support they needed and that staff were available when required. At the time of the visit 13 care staff were employed at Avarest. Documentary evidence was available to confirm 7 staff (53.84 ) had completed a National Vocational Qualification (NVQ) at level 2 or above. The owner / manager reported that a further three staff (23.07 ) had also completed a NVQ however no certification was available to confirm this. Care Homes for Older People Page 22 of 30 Evidence: The Annual Quality Assurance Assessment (AQAA) for Avarest confirmed a policy for recruitment and employment was in place. Since the last visit 7 staff had commenced employment at Avarest. This number consisted of 5 care staff, a cook and a cleaner. The personnel files of three care staff were viewed. Each file contained the necessary documentation required under the Care Home Regulations 2001 and copies of application forms, health declarations, proof of identity, two references, Protection of vulnerable adults (POVA) and / or Criminal Record Bureau (CRB) checks were available for reference. It was noted that staff had commenced employment before two written references and / or a POVA or CRB check had been received. POVA and / or CRB checks were also examined for the other four new staff. Each employee had evidence of a POVA or CRB check on file however records revealed that three of the staff had commenced employment prior to a POVA or CRB check having been received. Training records confirmed that new staff had completed a TOPSS (Training Organisation for Personal Social Services) induction and the owner / manager reported that she was supporting staff to also complete the Skills for Care Common Induction Standards. The manager was reminded that new staff must complete the Skills for Care Common Induction Standards within 12 weeks of commencing employment. Examination of the homes training matrix and individual staff training records highlighted that staff had access to a range of training including: induction, safe working practice, safeguarding adults, medication and National Vocational Qualification Training. Systems were also in place to monitor the ongoing training needs of staff and when refresher training was due as previously noted. Staff spoken with reported that they had access to ongoing training and were complimentary of the training and support received. For example one member of staff reported The management really look after the staff well with courses offered and training updated all the time. They are really nice to work for and with. The majority of training was delivered in-house by the owner / manager who continued to teach a range of social care courses at a local college. The service continued to hire external trainers for medication, safeguarding adults and food hygiene training. It was recommended that the training programme be extended to include other training including equality and diversity, dementia etc. Care Homes for Older People Page 23 of 30 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. Systems are in place to ensure management and administration systems at Avarest are monitored and kept under review, to ensure the service is run in the best of residents. Evidence: The Manager (Pat Wright) was registered with the Care Quality Commission and had owned / managed Avarest since approximately 1989. Previous inspection records confirmed the manager had completed the necessary qualifications for her role. The qualifications included the National Vocational Qualification (NVQ) level 4 Registered Managers Award; NVQ level 4 in Care, City and Guilds Advanced management in Care and NVQ D32/D33 (Assessment), D34 (Internal Verifier) and D36 (External Verifier) training. Discussion with the owner / manager and examination of the training matrix for Avarest confirmed the manager had continued to keep her safe working practice Care Homes for Older People Page 24 of 30 Evidence: training up-to-date and the manager demonstrated an understanding of the need to undertake training periodically to update her knowledge, skills and competence. Feedback received from residents, relatives and staff confirmed the manager communicated a clear sense of direction and was helpful, open and transparent. The owner / manager continued to hire an external consultant to undertake an annual quality assurance assessment. The last assessment had been completed during May 2009. The assessment involved distributing an annual questionnaire to residents and their relatives each year, to find out their views on the service provided. The outcome of the most recent assessment indicated that there was a high satisfaction level (99.877 ). The results had been published and were displayed in the hallway for people to view. Staff spoken with confirmed they attended staff meetings periodically and records of the meetings had been recorded in a log book for reference. No resident meetings had been coordinated as previously noted as the people using the service preferred to speak to the manager or senior staff on an individual basis. The Annual Quality Assurance Assessment (AQAA) for the service detailed that policies and procedures on the Management on the management of Service Users Money, Valuables and Financial Affairs had been developed. The owner/ manager reported that residents were encouraged to manage their personal finances independently or with support from family members or personal representatives. The manager reported that she did not act as an appointee for any residents and systems had been established to collect fees via standing orders or cheques. At the time of the visit the owner / manager assisted one resident to manage their social security benefits and looked after the personal spending money for two other residents. Basic records were maintained together with receipts. Advice was given to the owner / manager on how to improve the records in order to safeguard all parties concerned. Pre-inspection records detailed that Health and Safety policies and procedures were in place and examination of the AQAA confirmed that test, maintenance and / or associated records were in place and up-to-date for all key areas. Fire log and service records were checked during the visit. Fire log records viewed Care Homes for Older People Page 25 of 30 Evidence: confirmed that the fire alarm system had been tested on a weekly basis and the emergency lighting each month. Records for the visual inspection of the fire extinguishers had not been appropriately maintained since December 2007 and this was brought to the attention of the owner / manager. Documentation was in place to confirm the fire alarm system and extinguishers had been routinely serviced and an up-to-date fire risk assessment was in place. Records had also been maintained to confirm staff had received fire instruction refresher training at appropriate intervals and monthly environmental / health and safety checklists were undertaken to safeguard health and safety. Care Homes for Older People Page 26 of 30 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 27 of 30 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 1 9 13 The administration of 28/08/2009 individual prescribed creams must be recorded on a Medication Administration Record. This will help to provide a clear audit trail and evidence that the creams have been correctly administered. 2 29 19 Staff must not commence employment at Avarest until two satisfactory written references and a Protection of Vulnerable Adults or Criminal Record Bureau check has been received. This will help to safeguard the welfare of the people using the service. 28/08/2009 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service User Guide should be updated to include the name and contact details of the Care Quality Commission. This will ensure people have access to key information on the current regulator. The Resident Assessment Prior to Admission form should be updated to include all the criteria outlined in Standard 3 of the national minimum standards to ensure an holistic assessment of needs is undertaken prior to admission. Care plans should be updated to include a section on aims / objectives and outline how the routine health care needs of the people using the service are to be met. Care plans should also describe in more detail the support required by staff in response to each residents personal, health and social care needs. This will provide staff with more detailed instructions on how to meet the needs of the people using the service. Medication risk assessments / disclaimers should be updated to specify the name of medication / inhalers and the dosage. This will help to provide evidence that individual residents fully understand the details of any medication they wish to administer. The range and frequency of in-house and social activities should be reviewed to ensure the social and recreational needs of all residents are met. A copy of the most recent fire officers report should be located and available for inspection for reference. Details of the daily hours worked by the owner / manager should be record on the rota to provide a clear audit trail. The training programme should be extended to include other training relevant to the care of older people including equality and diversity and dementia. Detailed records of financial transactions should be maintained for any money handled on behalf of the people using the service to ensure best practice and a clear audit trail. The fire extinguishers should be visually inspected on a monthly basis and records maintained to ensure safe working practices. 2 3 3 7 4 9 5 12 6 7 8 19 27 30 9 35 10 38 Care Homes for Older People Page 29 of 30 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. 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