Care Home: Aveley Lodge

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• Claremont House
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What the care home does well People who use the service and said that staff spoken to them in a friendly fashion, with respect, and they welcomed visitors to the service without restrictions. Premises and accommodation visited were well maintained and decorated. Garden areas provide pleasant areas for people to sit outside. Rooms visited were personalised. Positive engagements and interaction were directly observed between the people using the service and the staff. Staff are trained well ensuring that they have the correct skills to meet the needs of the people using the service at all times. One person using the service stated, “I like it here, the staff are kind and we get lovely food”. Medication systems are well managed and people are fully supported in the safe administration of their medication. Activity provision for the people who use the service is thoughtful and stimulating. People are encouraged to engage in meaningful activities and thought has been given to the activities provided. What has improved since the last inspection? Many improvements have been made to the service since the last inspection, this includes the employment of a full time activity coordinator, who provides a wide range of stimulating activities for the people using the service. Care plans are in place for individuals and provide a person centred approach to the care being provided. Although some information in the care plans and assessments is sparse the care, support and guidance being offered to the individuals is tailored to individual needs at all times. People using the service are very complimentary of the services that they receive. Staff are provided with suitable and appropriate supervision. This now includes one to one formal supervision, medication administration supervisions, annual performance supervisions and observational practices. The service has a bi annual quality assurance system in place and has identified within the AQAA the further improvements that are to be made to ensure that the information obtained is fully actioned and recorded. The service is currently using a new medication administration system which has improved the management of medicines. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.2 A number of environmental improvements have been made and include replacement of the dinning room flooring and curtains. The radiators have been covered, bedrooms doors have photographs on them and numbers, redecoration throughout the service is ongoing, including bedrooms to individuals choices and wishes. A number of carpets have been replaced and plans are in place to refit the kitchen before the end of December 2009 and the second dinning room floor is to be placed. A new large screen television has been purchased for one of the lounges and a fish tank providing visual stimulation for the people using the service. The small garden area to the front of the service has been gated enabling people to move entirely around the service without restriction. What the care home could do better: The storage of oxygen must be identified by the use of illuminating signs. Key inspection report CARE HOMES FOR OLDER PEOPLE Aveley Lodge Abberton Road Fingringhoe Colchester Essex CO5 7AS Lead Inspector Louise Bushell Key Unannounced Inspection 8th October 2009 10:30 DS0000017757.V378261.R01.S.do c Version 5.3 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. Aveley Lodge DS0000017757.V378261.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 Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aveley Lodge Address Abberton Road Fingringhoe Colchester Essex CO5 7AS 01206 729304 F/P 01206 729304 michael.parmenter@aveleylodge.co.uk www.aveleylodge.co.uk Mr Robin Parmenter 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) Mr Michael Ian Parmenter Care Home 21 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (21) of places Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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 Dementia - Code DE The maximum number of service users who can be accommodated is 21 3rd September 2008 2. Date of last inspection Brief Description of the Service: The service is situated in the village of Fingringhoe, Essex, and benefits from being within reasonable bus / car ride of a range of local amenities provided by the historical town of Colchester. Aveley Lodge offers a number of single rooms, some of which have en-suite facilities. The home has two lounges and a conservatory area. Extensive grounds can be found to the rear of the property. The fee range for residing at the care service is from £515.00 per week to £540.00 per week, with an additional charge made for hairdressing and chiropody. This information was provided to the inspector at the time of the inspection. Aveley Lodge DS0000017757.V378261.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 star. This means the people who use this service experience good quality outcomes. The focus of the inspections undertaken by the Care Quality is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 3rd September 2008. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service if they were available. The visit took place between 10:30 am and 16:00 pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the manager. As part of this inspection we also used the expertise of a person who has expertise by experience. We call this an expert by experience. The expert by experience was involved throughout the inspection process and met with a number of people using the service, talking to them and gaining their views. The expert also directly and indirectly observed staff practices and approach. The role of the expert is to experience the service from the perspective of the people using the service to assess what it is like to live in the care service and if the outcomes are in the best interest of the individual. The expert produced a report as part of the process and extracts of this have been included throughout the entire report. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.2 Page 6 What the service does well: People who use the service and said that staff spoken to them in a friendly fashion, with respect, and they welcomed visitors to the service without restrictions. Premises and accommodation visited were well maintained and decorated. Garden areas provide pleasant areas for people to sit outside. Rooms visited were personalised. Positive engagements and interaction were directly observed between the people using the service and the staff. Staff are trained well ensuring that they have the correct skills to meet the needs of the people using the service at all times. One person using the service stated, “I like it here, the staff are kind and we get lovely food”. Medication systems are well managed and people are fully supported in the safe administration of their medication. Activity provision for the people who use the service is thoughtful and stimulating. People are encouraged to engage in meaningful activities and thought has been given to the activities provided. What has improved since the last inspection? Many improvements have been made to the service since the last inspection, this includes the employment of a full time activity coordinator, who provides a wide range of stimulating activities for the people using the service. Care plans are in place for individuals and provide a person centred approach to the care being provided. Although some information in the care plans and assessments is sparse the care, support and guidance being offered to the individuals is tailored to individual needs at all times. People using the service are very complimentary of the services that they receive. Staff are provided with suitable and appropriate supervision. This now includes one to one formal supervision, medication administration supervisions, annual performance supervisions and observational practices. The service has a bi annual quality assurance system in place and has identified within the AQAA the further improvements that are to be made to ensure that the information obtained is fully actioned and recorded. The service is currently using a new medication administration system which has improved the management of medicines. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.2 Page 7 A number of environmental improvements have been made and include replacement of the dinning room flooring and curtains. The radiators have been covered, bedrooms doors have photographs on them and numbers, redecoration throughout the service is ongoing, including bedrooms to individuals choices and wishes. A number of carpets have been replaced and plans are in place to refit the kitchen before the end of December 2009 and the second dinning room floor is to be placed. A new large screen television has been purchased for one of the lounges and a fish tank providing visual stimulation for the people using the service. The small garden area to the front of the service has been gated enabling people to move entirely around the service without restriction. 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. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4 and 5. 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. Information about the service is kept up to date and provided for all prospective users. Everyone wishing to enter the service has a basic assessment of needs completed. This ensures that all parties can be sure the service can meet individual needs. EVIDENCE: The service has developed a statement of purpose, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care the service offers. The guide details what the prospective residents can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. All Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 10 residents are given a copy of the guide. It was also established throughout the inspection that people have copies of all documents available in the foyer of the service and the guide in their bedrooms. When requested the service can provide a copy of the statement of purpose and guide in a format which will meet the capacity of the resident. The AQAA tells us that first contact with Aveley Lodge Residential Home in normally our new web site which provides most of the information needed and can also take information to help decide suitability for both parties from those enquiring and relay this information direct to the homes management via email. However, Aveley Lodge also operates an enquiries database system which records first contact information with the care home. Pre-admission assessment which takes into consideration psychosocial, physical, religious and social needs. Most information requested from Aveley Lodge is provided upon request (although some is only given when the perspective resident or their family arrive for a viewing of the home). Aveley Lodge operates an open house policy which allows individual or small groups to view the home upon arrival without the need to pre-book a visiting time. Admissions are not made to the service until a full needs assessment has been undertaken. A skilled and trained person always completes the assessment prior to admission to the service. The assessment format is basic in style, however seeks to establish the primary care needs of the individual prior to admission. The assessment explores fifteeen areas of physical health care needs, including personal care tasks. Each defined area is then further explored . For example the section on personal care is further defined and states one carer to assist with personal care. In addition to this physical well being stated, dementia, sight stated, poor. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. The assement format did not fully explore the diverse needs of the person using the service. A total of two care plans were case tracked. The assessments of the two people case tracked determined that the exploration of diversity and cultural issues were minimal. There was a section for the assessor to explore the religion needs of the individual, however this was not completed.This was brought to the attention of the manager and deputy manager during the feedback session. During the inspection time was spent talking to the people using the service. It was established that a married couple had recently moved into the service. The expert by experience spent time talking to them and gathering their views about the process. The expert by experince commented, I then met a lovely married couple, who had only been living in the home for three days. They had a lovely double room, with a double bed, and two armchairs placed side by side. They told me very honestly about how traumatic it had been having to leave their home, but how grateful they were to be able to be together. They both commented on how unhappy they would be if they were separated, and recognised how fortunate they were. They told me that their daughter had visited several homes on their behalf, as they were too frail to do so, and that she had told them that she felt Aveley Lodge was just right for them. They were full of praise for the care they had so far received. One individual stated, Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 11 “the staff treat us wonderfully well” and “I am so pleased to see how well they look after my wife”. The expert by experince stated in her opinion that the staff had clearly done a fantastic job in helping them to settle in, to have such positive feedback after just a few days. The expert by experince also directly observed staff intercation and stated in their report that the member of staff who came into the room, treated them with incredible kindness and understanding, and got them both laughing. It was estbalished that although the administrative paper work relating to the admission and assessment of the people using the service, lacks depth and detail, the main outcomes for the individuals are met and that the service has the capacity to support people who use the service and respond to diverse needs. Staff supporting people were seen to interact with total respect and dignity for the individual at all tmes. Discussions with staff further supported the notion that although administrative systems may lack detail that the knowledge of all staff is detailed, current and accurate to the needs, wishes and prefernces of the person. Privately funded people who use the service are provided with a statement of terms and conditions or a contract. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. People who are funded receive a social service contract. Contracts are reviewed when there is a change in the needs of the person using the service. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 12 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): Standards 7, 8, 9 and 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. People using the service can be assured that their personal care and health care needs are met and that their care plans provide adequate information in order for staff to ensure the care is tailored to individual preferences and needs. EVIDENCE: A total of two care plans were case tracked fully, it was established that people who use the service receive personal and healthcare support using a person centred approach. Personal healthcare needs including specialist health; nursing and dietary requirements are recorded in each persons care plan. The care plan provides clear information and a comprehensive guide for staff to know how to support the person. The care plan is generated from the pre admission assessment and includes, risk assessments for the management of Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 13 falls, bed rails, manual handling and self medication. The care planning format explores and outlines the individual needs and preferences of a person. The care plan is written from the perspective of the individual and throughout documents the persons own preferences and wishes. For example the persons choice of clothes, personal hygiene preferences and style of hair. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. A good practice example of this was seen at the service, where staff were able to spent time chatting with people and reading magazines and news papers with them. The atmosphere and approach of the service is very friendly and home from home. One person using the service stated, they are like my family here, so friendly and so kind. The service listens and responds to individual choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs as appropriate. Within the care plan there is a document called to be accepted and understood as an individual. This document explores how the person would like to receive the care and support being provided. An example observed detailed the preferences of the individual and what they would like to be called. The expert by experience commented in their report that whilst I was sitting in the lounge, I observed a member of staff, who had picked up one of the residents knitting, and knowing that she sometimes dropped stitches, sat and quickly repaired it, so that her knitting did not run, as she knew she would have been very upset if she had later noticed. I was very impressed with this level of thoughtfulness. Residents have access to healthcare and remedial services. The health care needs of residents unable to leave the service are managed by visits from local health care services. Clear evidence was seen in the care plans of specialist health care support services visiting the service and in addition to the care plan there were detailed notes made by the specialist visiting the service for example the District Nursing team and General Practitioners. A number of comments were received directly from people that use the service. One person commented that, I consider that the service does every thing to make the residents happy in every way they can, such as entertainment, good food, outings and caring. The AQAA tells us that Aveley Lodge provides a home where privacy and dignity are integral to the running of our business and the homes success. Residents care plans are tailored to the individual and reviewed on a regular basis. This ensures we are always working towards providing the best possible outcomes for those using our service. All healthcare needs are recorded and reviewed. Reviews are either conducted by the home or visiting professionals (recorded accordingly). During the inspection it was directly observed that care plans were reviewed on a regular basis. It was observed that one of the documents in place reviews and assesses the person’s level of independence. Whilst this tool provides the reader with an over of the assessed needs, improvements and deterioration, it Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 14 did not note any further actions to be taken as a result of the review. For example in the section, maintaining a safe environment, both the service user and the key worker ticked the box the state that they are unable to meet needs. In the next comments section the key worker had added prone to falls. No further actions had been added. This was brought to the attention of the deputy manager and the manager who agreed a referral to the falls coordinator would occur. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. A total of three people’s medication was case tracked in order to ensure compliance. Room temperatures were being recorded in all the medication rooms. Ordering and returns documentation was up to date and accurate. The service works with individuals regarding any refusal to take medication. The people using the service are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff can manage medication on their behalf. Thought has been given to providing safe but sensitive facilities for keeping medication. Risk assessments are in place for the self administration of medicines. The service has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. On the day of the inspection it was directly observed that people who use the service were being supported and provided with specialist treatment in their own rooms and in private. The service has recently changed the provider of medication to Bio Dose. The new system of medication offers a safer administration system where by all medication is pre sorted as per the prescription of the individual. This includes liquid medications. The service discussed the advantages of this system and how this has improved the management of medication within the home. Discussions occurred with the deputy manager regarding hand written entries made on the Medication Administration Record. The service did not have a current copy of the Royal Pharmaceutical Guidelines in place. The AQAA tells us that, all medication is provided in a sealed and simple system by Queen Street Pharmacy, training is also provided annually by the same people as well as nationally accredited qualification being obtained by the homes senior staff. In addition to medication training, all staff receive full and annual training so that they are able to provide privacy and dignity, and how to deal with those dying and death itself. Moreover, how to support those at the time of and after care (families). All resident are informed of their right to self medicate and would be fully supported by the home senior staff. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 15 The expert by experience spent time talking to a number of people using the service. Within the report completed it stated after lunch I chatted to an X who once again was full of praise for the care received and stated “I am the happiest here I think I have ever been. The staff are wonderful, I always look forward to my food, and I always clear my plate”. The expert by experience also received further comments, which stated, “I wouldn’t change anything – the staff are always so kind to me, and nothing is too much trouble for them. I feel very well cared for.” Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 16 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): Standards 12, 13, 14 and 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 services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from people using the service determined that they are able to receive visit from friends and family at any reasonable hour. A number of people that use the service have stated that they the staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. The report completed by the expert by experience commented, I wandered into one of the lounge areas, where the activities co-ordinator was playing bowls with the residents sitting in there. She spent quality time with each person who wanted to play, and it was lovely to see her inter-reacting Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 17 with them all, obviously having a great relationship with them all. She was very good at adapting the game for those who were less physically or mentally able, so that they all retained their dignity and were able to enjoy it. The activity caused quite a lot of conversation between the residents, as they cheered one another on, which was pleasing to see. During the course of observing this activity, I chatted to a number of the residents who were not playing, and when I casually asked X whether X had always lived in the area, X could not remember and looked over to a member of staff, who immediately reminded X of where she had lived. I was tremendously impressed at this example of how well the staff know those receiving care at Aveley Lodge. During the day there were many such incidents, which contributed to the very personal, homely feel to the care provided. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. The staff team help with communication skills, both within the service and in the community, to enable residents to fully participate in daily living activities. One person using the service commented I’ve never been so happy as since I’ve been here” and “all the staff are lovely, the food is excellent, and I can’t praise it enough. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They have been fully involved in the planning of their lifestyle and quality of life. Where appropriate, education and occupational opportunities are encouraged, supported and promoted. Aveley Lodge has made many improvements over the last twelve months. One of these improvements includes the further development of the monthly Aveley News letter. In addition to this people are supported and encouraged to attend the local social club and make suggestions for the running of the service. People using the service are encouraged to attend the monthly service user meeting. Minutes of these meetings were reviewed as part of the inspection process. It was pleasing to see that the views and opinions of the individuals are noted and actions taken as a result. An example of this was observed where a person had commented that they did not want mash potato any more. Residents can access and enjoy the opportunities available in their local community, such as using public transport, library services, the local pub, and local leisure facilities. In addition to further improvement’s made Aveley Lodge now employs a full time activities coordinator. On the day of the inspection a number of people were observed sitting in the lounge area listening to the radio as it was national poetry day. All people looked warm, relaxed comfortable and well cared for. The AQAA tells us over the past 18 months Aveley Lodge has greatly increased its contacts within the local community. As a result, nonrelated visits have increased and there are more local groups wanting to Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 18 become part of life in Aveley Lodge. All the activities both internal and external are clearly recorded in both the individual care plans and the daily activities log. All contact is welcomed and made more available by the homes open door policy. During the inspection process and case tracking it was observed that records of activities provided and those participated in, are well maintained. The service also completes an activity assessment document. On review, it was found that one of the files case tracked contained this whilst another did not. This was a detailed useful documents and this finding was brought to the attention of the manager and the deputy manager. The activity events board is displayed within the service, however at the time of the inspection the board was not creatively and or adequately displaying the activity available and planned. People using the service may have experienced problems in reading this information. This was discussed with the manager and deputy manager of the service. The AQAA tells us that the introduction of monthly new letter for both resident and relatives (copies differ when necessary). These newsletters allow the management to discuss and answer questions in a public forum. It also enables the home to keep both residents and relative informed of any changes or issues in the daily life of the home. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. People using the service commented that they have choices of the meals they are provided with and are supported to draw the menu up. The expert by experience commented in her report, I then observed lunch being served, which looked and smelt very appetising. The chicken pie, and vegetables was described as “lovely” and everyone seemed to thoroughly enjoy it. It was particularly pleasing to see what a social event lunch became. There was lots of banter between staff and residents, which often resulted in fun and laughter. Again, it was obvious how well the staff knew each person, as some clearly wanted to be left alone to eat in peace, whilst others revelled in the social interaction. Juice was readily available, and more was offered where required. I was offered a bowl of chocolate pudding with chocolate sauce, which looked and, more importantly, tasted beautiful. A very bubbly, pleasant person explained to me that they did not have a sweet tooth, so always had yoghurt, and explained that they always brought two yoghurts “because I really love them”. Any of the residents, who needed a little assistance, or coaxing, were helped, but none of the staff took over or hurried anybody. They were incredibly kind, and patient. For some of the time, I was sitting in the next door lounge but listening through an open door to very happy conversation. The staff would have been unaware that I was there, but their attitude remained consistently gentle, and caring with comments such as “this will build your strength up, we don’t want you fading away, do we” and “if you need some help you just ask, won’t you, my dear”. When one of the residents thanked a member of staff, she smiled sweetly, and said, “you’re very welcome”. Lunch was altogether a pleasant, Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 19 relaxed and happy time; it reminded me of an extended family eating together. In addition to this, the AQAA tells us “mealtimes, these are times for residents to come together as a group and chat and build relationships / friendships. The staff of Aveley Lodge work hard to keep these informal and relaxed. The residents are made to feel like part of the team by being allowed and encouraged to help in the preparation and clean up of meal times (where safe and right to do so). This involvement is furthered by the three week rotating menu being constructed by the residents of Aveley Lodge and reviewed on a six month basis (with help and guidance from the catering team and management). All residents of Aveley Lodge have the right to remain in their bedrooms and opt out of group activities and mealtimes in the communal areas. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of supporting at the pace of the individual, making them feel comfortable and unhurried. The expert by experience added further, “after lunch I chatted to a person who once again was full of praise for the care they received. “I am the happiest here I think I have ever been. The staff are wonderful, I always look forward to my food, and I always clear my plate”. Another person said, “I wouldn’t change anything – the staff are always so kind to me, and nothing is too much trouble for them. I feel very well cared for.” I moved on to sit in the conservatory, overlooking the lovely gardens and country views. The visiting hairdresser was there throughout the day, cutting and styling the resident’s hair. She was a very friendly and chatty woman, who said she had been visiting the home for about 15 years. She was very complimentary of the care given, and atmosphere within the home, commenting on the fact that many of the staff have been there for several years, which adds to the continuity of care, and a sense of “family”. Whilst chatting to her, and the person who was having their hair done, I commented on the long line of washing blowing in the breeze outside. The hairdresser said how much the residents liked watching the washing on the line, and it starts conversations about when they used to do it. She stated that one of the residents likes to help with hanging out the washing, and that the staff are happy to include her when she wants to do it. I thought this was a lovely touch, and probably made the lady concerned feel useful and valued. The service has identified within the AQAA further improvements it is aiming to make over the next twelve months, this includes, “further training for all staff (focused on activities staff) in the area of holistic social, psychological, physical, and spiritual needs for those using our service. To obtain the service of a physiotherapist for the residents of Aveley Lodge. To construct a purpose built activities and relatives day room. Further improvements in social contact / stimulation and external input would be organised from the results / findings of our quality assurance programme”. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 20 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): Standards 16, 17 and 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. The service has a robust complaints procedure in place, good staff awareness and attitude towards safeguarding issues so people who use the service are safe and protected. EVIDENCE: The service has an open culture that allows residents to express their views and concerns in a safe and understanding environment. People who use the service have commented that they are happy with the service provided; feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. The service has a complaints procedure that is clearly written and easy to understand. It is available on request in a number of formats. The complaints procedure is supplied to everyone living at the service and is displayed in a number of areas within the service. There has been one formal written complaints to the service, which has been investigated and responded to within the time scales as required. The AQAA tell us that “Aveley Lodge operates a clear and well understood policy on concerns and complaints whistle blowing and bullying. All residents are informed of these policies on Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 21 arrival into the home and reference to these is in the service user’s guide. All complaints raised by resident, relatives, staff, or professional bodies in writing are recorded in the complaints log along with any response from Aveley Lodge and outcomes to any required investigations”. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. Staff had a clear understanding of whislteblowing and when the use of this policy may be put into practice. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. Training of staff in safeguarding is regularly arranged by the Service. The AQAA tells us that over the past year we have only received one formal written complaint. This has been investigated and the involvement of social services was necessary. The outcome was no action needed by Aveley Lodge. Aveley Lodge did take action to help the individual involved so that they may feel better supported by our service. The low level of complaints is help by all staff receiving annual training in the application and implementation, understanding and respecting of individual human right, D.O.L.S (Deprivation of Liberty and Safeguards), The Mental Capacity Act and Protection of Vulnerable Adults, along with the right to dignity, respect, choice, and independence. The expert by experience stated “I came away from Aveley Lodge, feeling very happy that the residents here have a very good quality of life, and are treated with the utmost dignity, and respect. I also felt that the staff genuinely cared for them, and tried, wherever possible, to tailor make the care to suit the individual rather than adopt a “one size fits all” policy. This perhaps takes more time and effort, but ultimately produces a very happy, and homely feel, which has to be beneficial to staff and residents alike”. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 22 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): Standards 19, 24 and 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 the service enables the people who use the service to live in a safe, well-maintained and comfortable environment which encourages independence. EVIDENCE: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. The service is a pleasant, safe place to live the bedrooms and communal rooms providing a personal homely feel. The layout of the building enables people to move freely with Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 23 several different seating areas throughout to encourage socialising or enabling the person to have privacy. The Annual Quality Assurance Assessment completed by the service determines that the internal and external improvements have been made to improve a homelier feel. The people who use the service appear like the changes made. One of the dinning room floors had recently been replaced and the other was due to be fitted latter on in the week. The people who use the service are encouraged to personalise their bedrooms. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The building is designed to support the needs of people who are aging. Thoughtful and appropriate additions to the environment have been made in particular flowers in the entrance lobby, creating a homely feel. In addition to this a number of improvements have occurred and includes, redecoration of communal areas and bedrooms, all radiators being covered, a new flat screen television in the main lounge, a new fish tank, new dinning room chairs, a number of new carpets, some new furniture in bedrooms, some new curtains and railings and gates to the front area of the building enabling people to move freely inside and outside whilst maintaining their personal safety. It was directly observed that all bedrooms are now numbered and some have pictures on them to help people depict their own rooms. The dining rooms are laid out to encourage communal dinning with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. In general, the people who use the service say that they like the decoration and that there is a nice garden to relax in. The garden has been adapted with time spent making separate seating areas and areas of interest for all the people who use the service. The expert by experience detailed in the report that “my first impressions of Aveley Lodge were very favourable, arriving on a beautiful sunny morning in the little village of Fingringhoe, which enabled me to fully appreciate the lovely surroundings of this care home”. In addition to this the expert wrote, “I first spoke to a person, who described how he had arrived at Aveley Lodge after a particularly tragedy, which had left X emotionally shattered, and “ready to give up”. But clearly, the staff at this home had performed wonders, as I spoke to X, X was positive, happy, and absolutely glowing in praise of all that was done. X stated “I’ve never been so happy as since I’ve been here!” and “All the staff are lovely, the food is excellent, and I can’t praise it enough.” When I asked X if there was anything he would like to change, he thought for a little while, and then stated, “No, I can honestly say there is nothing at all – it’s just lovely”. X had the most beautiful bedroom, with lovely views of the garden, and patio doors, which Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 24 opened out right by a lovely fishpond. X told me that X liked to be responsible for feeding the fish, which X was clearly very proud of”. The home has a sound infection control policy. The manager of the service has identified works throughout the forthcoming twelve months that will be completed; this includes “the installation of an industrial kitchen (as designed in relationship with Health and Safety and Environmental Health officers). Installation of new industrial laundry equipment which meets all current and foreseen regulations along with service plans”. The service is clean, well lit and in general smells fresh. There was an infection control policy in place and in discussion with the staff and observation of care practice demonstrated that the infection control practices were being followed. There was restricted access to high-risk areas such as the main kitchen and the laundry areas to reduce the risk of cross infection. The manager spoke to the inspector about the planned refurbishment of the kitchen in December 2009. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 25 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): Standards 27, 28, 29 and 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. People using the service can be assured that staff are suitbale recruited, supervisied and trained in order to meet peoples needs at all times. EVIDENCE: The people spoken with and from information gathered from a number of surveys determines that they have confidence in the staff who care for them. Rotas were seen and displayed adequate staffing numbers on duty to meet the needs of the people suing the service. Specific attention was given to the busier periods of the day. A deputy manager was usually on shift and on occasion supernumerary to the care staff. This enable the service to ensure that numbers were maintained for the safety of all and that record keeping was completed and monitored as required. A manager was usually on site in addition to this. Staff members undertake external qualifications beyond the basic requirements. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 26 clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are consistently able to meet their needs. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. A total of five staff files were audited and were seen to contain all the required documentation. The AQAA tells us that the “staff rota is designed to ensure correct levels of staff are scheduled to care for the dependency level within Aveley Lodge at that given time. It also allows individual staff to be accountable for specific tasks. Aveley Lodge employs most full time employees who are all trained in either NVQ 2 or 3 plus many other additional qualifications to the mandatory subjects. Full time employees are preferred by the home as we feel this improves continuity of care for our residents and reduces the risk of communication error. Aveley Lodge has a staff recruitment policy, which is strictly adhered to. All information appertaining to recruitment, selection and employment are store at Aveley Lodge for any future reference. Training of staff at Aveley Lodge is undertaken by approved training providers and is completed annually by all staff. Employees are also encouraged to undertake additional training other than that offer under the homes training policy. This is reinforced during staff supervisions and annual appraisals where training targets are discussed, set, and monitored”. Training records reviewed, reflected that all mandatory training was up to date and well managed by the service. Additional distant learning training had been accessed in Palliative Care, Equality and Diversity and Medication. Four individual staff commented on the strong team culture of the service and felt that following recent recruitment that there are enough staff on duty to meet the needs of the people who use the service. Staff recruited confirmed that the service was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans for cover for vacancies and sickness and the service does not use agency staff. An on call procedure is in place to support staff as required. Staff confirmed that the senior team provide supervision; records showed that supervisions are completed on a regular basis. The supervision process includes observational supervisions, medication administration supervision, one to one supervisions and annual performance reviews. Staff meetings take place regularly. Notes and action points are taken of meetings and sessions, and progress is regularly reviewing. The mix of staff is suitable to meet the cultural needs and mix of people that use the service. People using the service could not praise the efforts of the staff enough. One person using the service commented, the staff are simply wonderful, so kind and caring in all they do. They treat us like individuals and love us dearly. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 27 Staff reported that they felt supported in their roles and that they were to discuss issues with a member of the senior team if required. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 28 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): Standards 31, 32, 33, 35, 36, 37 and 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. People using the service can feel assured that the manager is suitably qualified and competent to run the service and provide trained competant staff in a safe and well managed environment. EVIDENCE: The Registered Manager has the required qualifications and experience and is competent to run the service. The Registered Manager and the deputy Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 29 manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve services. There is a focus on person centred thinking, with the people who use the service becoming increasingly more involved. The AQAA tells us that “Aveley Lodge is well run and privately owned home by one family which works endlessly with its staff to provide and safe, warn, comfortable, and professional environment for its residents to live”. One person using the service commeneted that “the manager is really kind and is always here if we need him”. The manager was directly observed throughout the inspection to lead by example and manage the service efficiently. The Registered Manager leads and support a stable staff team who have been recruited and trained satisfactory levels. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The AQAA tells us that “it is a place where one’s ethnic, cultural, religious, sexual or political views or preference are not disregarded nor disrespected. A place where staff at all levels are trained and supervised to uphold the home beliefs and ethos along with those held true by the individuals using the service”. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. The home works to a clear health and safety policy. Health and safety is well organsided and managed throughouyt. Records are very well ordered and maniatened. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. Recent in house training has occurred regarding safeguarding issues. Staff confirmed that this was productive and showed a sound working knowledge of action to take in such an event. During the visit to the service it was observed that CCTV was operating in communal areas of the service. The manager stated that this is due to the service being rurally situated and for safety reasons. The manager stated that the recording are kept off site and are strictly confidential. It was observed that no private areas were monitored, just commual corridoors and enternances. This is detailed in the services statement of purpose. The service hold a clear fire safety risk assessment and policy. The grounds of the service are mapped and clearly displays room area’s and high risk areas such as those where oxygen is stored. These are represented by notices. Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 30 Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 31 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 32 Are there any outstanding requirements from the last inspection? No 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 OP38 Regulation 13 (4) Requirement Illuminating signs must be used to identify the location and storage of oxygen within the building. To ensure that any risk associated within the storage of oxygen is minimised as required. Timescale for action 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Aveley Lodge DS0000017757.V378261.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission 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. 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