Care Home: Avens Court Nursing Home

What the care home does well The atmosphere between staff and people using services and their visitors was warm and friendly. The home has a clear admissions criterion. Admissions are not agreed until the home`s management can be confident that needs can be met, based on the findings of a comprehensive needs assessments carried out by a skilled and competent member of staff. Individualised care plans are generated from needs assessment for meeting health and personal care needs. Discussions with relatives and visitors of people using services confirmed an inclusive approach to assessment and care planning. A relative of a person recently admitted to the home stated that when he visited Avens Court to view the home his contact with staff gave him confidence that they knew what they were doing and he had been impressed by their caring approach. Recognition of equality and diversity is embedded in the organisation`s policies and procedures, underpinning the admission criteria, care planning, staff recruitment and training. The relative of a person whose father`s admission was unplanned owing to an emergency and who had not stayed at the home before, stated how well the home had responded to his father`s cultural and diversity needs. He credited his father`s speedy adjustment to his new surroundings to how well this had been managed. He expressed opinion that the staff at Avens Court had a good approach and understanding of the needs of people with dementia. His father told us that he liked the home and the staff. People using the home`s services have varying degrees of choice in their daily lives, dependent on capacity and understanding. There is opportunity to engage in an in-house social activities programme and for maintaining contact with family and friends. The environment was safe and hygienic, mostly well maintained and comfortable. Overall feedback from visitors we spoke with was positive about the home and the staff. What has improved since the last inspection? What the care home could do better: The inspection visits identified major shortfalls in catering standards compounded by poor teamwork and communication in the kitchen, their high workload and management inaction in dealing with staff conflict affecting the cook`s ability to control the kitchen environment. The findings included failure to ensure sufficient and functioning kitchen equipment and appliances, lack of food choices for people using services and no provision of soft diets for those assessed to require the same. The home manager responded to these findings and implemented an action plan for improvement, which included an immediate increase in staffing levels in the kitchen. These shortfalls raised questions about the adequacy of management audit systems and monitoring and supervision of meal times. Also regarding the value base of individual staff members. Consideration could be given to addressing this with the whole team through further training and work on value setting. A shortfall in staff vetting procedures outside of the home manager`s direct control was identified through the efficiency of new systems being implemented by the manager. Appropriate action was immediately taken in this matter. Observations of staff files identified the need for review of staff recruitment, vetting and recording practices at the organisation`s head office. Problems affecting the heating system continue, despite the replacement of two boilers since the last key inspection. Heating engineers are regularly called out and a system is in place for monitoring and recording room temperatures. A requirement was made for shortfalls in bathing facilities to be rectified in the best interest of people using services. The parker bath on the third floor was not working and the bathroom on the first floor was in a poor state of repair and the bath unusable. Bathing facilities do not meet the needs of the people using services and a requirement has been made for this to be addressed. Current bathing facilities across the three floors are none on the second floor, one shower on the first floor and three showers on the ground floor. The information received confirmed a number of people using services are frightened and distressed by the experience of taking showers. Whilst the home`s management generally promotes safe working practice some shortfalls were identified and are detailed in the body of this report in the quality area entitled Management and Administration. Having fully discussed these with the manager we are confident in her commitment to making the necessary improvements. CARE HOMES FOR OLDER PEOPLE Avens Court Nursing Home Broomcroft Drive Pyrford Woking Surrey GU22 8NS Lead Inspector Pat Collins Unannounced Inspection 28 November 2008 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avens Court Nursing Home Address Broomcroft Drive Pyrford Woking Surrey GU22 8NS 01932 346237 01932 336686 sj_parkin@yahoo.co.uk 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) Surrey Rest Homes Ltd Mrs Sarah-Jane Parkin Care Home 60 Category(ies) of Dementia (0) registration, with number of places Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 60. Date of last inspection 21st April 2008 Brief Description of the Service: Avens Court is a privately operated care home with nursing providing dementia care for older people of both genders. Situated in a quite residential area within a short distance of shops and community amenities, Avens Court is a large detached house that has been extended. Car parking facilities are available at the front of the building and an enclosed, secure garden is provided at the rear. Single and shared bedroom accommodation, some with en-suite toilet facilities, is arranged on three floors, accessible by two passenger lifts. There is a dining room on the ground floor and communal sitting rooms on the ground and first floor. Weekly fee charges range between £449 and £650, excluding the RNCC weekly payment of £103. Additional charges apply for hairdressing, chiropody, aromatherapy, hand massages and facials, also for personal newspapers and magazines. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Stars. This means people using the homes services experience good quality outcomes. The homes last key inspection was on 22nd January 2008. Since then an unannounced random inspection was carried out on 21st April 2008, focused on the quality of care provision and wellbeing of people using the homes services. Copies of the random inspection report are available to the public, on request. This key inspection was undertaken by one inspector and included two unannounced visits to the home on 28th November and 12th December 2008. Inspection visits form part of the key inspection process using the Inspecting for Better Lives methodology. The report will say what we found as it is written on behalf of the Commission for Social Care Inspection (CSCI). The registered manager was present throughout both visits. Judgements about how well the home is meeting the national minimum standards for older people and quality of care are based on the inspection findings and cumulative assessment, knowledge and experience of the home since its last key inspection. We have also considered feedback received from people using services, a healthcare professional, visitors and staff. The inspection process incorporated a tour of the premises and garden, visiting all communal areas, the kitchen, utility room, staff room and some bedrooms. We sampled various records also policies and procedures. Direct and indirect observations were carried out of care practice, medication administration, group and one to one social activities. We also looked at menus and catering practices, the presentation of food and organisation of meal - times. Judgements about the wellbeing of people using services that we were unable to communicate with due to their disorders have been based on observations of their body language, appearance and behaviours; also on information in records and their interaction with staff and their environment. We wish to thank all who contributed information and participated in the inspection. We are grateful to all people using the homes services, the home manager and staff for their time, hospitality and cooperation during the visits. What the service does well: Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 6 The atmosphere between staff and people using services and their visitors was warm and friendly. The home has a clear admissions criterion. Admissions are not agreed until the homes management can be confident that needs can be met, based on the findings of a comprehensive needs assessments carried out by a skilled and competent member of staff. Individualised care plans are generated from needs assessment for meeting health and personal care needs. Discussions with relatives and visitors of people using services confirmed an inclusive approach to assessment and care planning. A relative of a person recently admitted to the home stated that when he visited Avens Court to view the home his contact with staff gave him confidence that they knew what they were doing and he had been impressed by their caring approach. Recognition of equality and diversity is embedded in the organisations policies and procedures, underpinning the admission criteria, care planning, staff recruitment and training. The relative of a person whose fathers admission was unplanned owing to an emergency and who had not stayed at the home before, stated how well the home had responded to his fathers cultural and diversity needs. He credited his fathers speedy adjustment to his new surroundings to how well this had been managed. He expressed opinion that the staff at Avens Court had a good approach and understanding of the needs of people with dementia. His father told us that he liked the home and the staff. People using the homes services have varying degrees of choice in their daily lives, dependent on capacity and understanding. There is opportunity to engage in an in-house social activities programme and for maintaining contact with family and friends. The environment was safe and hygienic, mostly well maintained and comfortable. Overall feedback from visitors we spoke with was positive about the home and the staff. What has improved since the last inspection? The home manager is now registered and the home and staff team is benefiting from much needed management stability and continuity also effective leadership. This has had a major impact on the quality of management systems resulting in significant improvement in a number of areas. The management team has been strengthened by the new provision of a deputy manager post within the structure. The senior management team are professional and hard working, implementing and sustaining improvements and developments in accordance with a clear improvement agenda. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 7 Modifications to the premises since the last key inspection have enhanced delivery of care and support to people using services. This has enabled implementation of a team working system for smaller groups of people with compatible needs and behaviours. Improvements to the décor and signage are underpinned by best practice dementia care design principles, where practicable, within the constraints of the building. The new development of two living units affords a more supportive and therapeutic environment. Significant change to the way staff are deployed has also enhanced care practice. Nurses and care staff are allocated to two teams, working under the direction of a two clinical senior nurse team leaders. Observations and discussions with staff and visitors confirmed this new arrangement had overall positive benefits for people using services. Staff said this enabled them to get to know the people they care for as individuals. Understanding of their non-verbal forms of communication had been enhanced, supporting a person-centred approach to care. Changes to the physical environment had created areas where people could sit in peace and quiet and others in more stimulating areas. The atmosphere of the home was overall calm, creating a positive dementia care environment. A relative commented that the dementia training received by staff had much improved their approach and understanding of her husbands needs. Further staff training has enhanced the skills and knowledge base of the staff team. Nurses have been trained to use the validated nutritional assessment tool implemented since the last key inspection. A system for monitoring weights ensured prompt action in respect of eating and swallowing problems, preventing significant weight loss. The home manager and her senior team are committed to sustaining the benefits of staff training through a structured staff management and support programme, alongside positive reinforcement set by their own good practice example. Individual staff were observed using appropriate touch when engaging with people using services, demonstrating skill and empathy in response to their emotions and feelings. It was good to observe the standard practice of staff taking time to explain to people using services what they are doing before doing it. An individual who had lived at the home for some time commented, everyone here is so nice and they all help me The homes link Community Psychiatric Nurse gave positive feedback about improved standards of care and the home environment, attributing the changes to the skill and drive of the home manager. Various visitors also made similar comments. There had been substantial improvement in arrangements and staffs approach for meeting the social needs of people using services, appropriate to their age and culture. What they could do better: Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 8 The inspection visits identified major shortfalls in catering standards compounded by poor teamwork and communication in the kitchen, their high workload and management inaction in dealing with staff conflict affecting the cooks ability to control the kitchen environment. The findings included failure to ensure sufficient and functioning kitchen equipment and appliances, lack of food choices for people using services and no provision of soft diets for those assessed to require the same. The home manager responded to these findings and implemented an action plan for improvement, which included an immediate increase in staffing levels in the kitchen. These shortfalls raised questions about the adequacy of management audit systems and monitoring and supervision of meal times. Also regarding the value base of individual staff members. Consideration could be given to addressing this with the whole team through further training and work on value setting. A shortfall in staff vetting procedures outside of the home managers direct control was identified through the efficiency of new systems being implemented by the manager. Appropriate action was immediately taken in this matter. Observations of staff files identified the need for review of staff recruitment, vetting and recording practices at the organisations head office. Problems affecting the heating system continue, despite the replacement of two boilers since the last key inspection. Heating engineers are regularly called out and a system is in place for monitoring and recording room temperatures. A requirement was made for shortfalls in bathing facilities to be rectified in the best interest of people using services. The parker bath on the third floor was not working and the bathroom on the first floor was in a poor state of repair and the bath unusable. Bathing facilities do not meet the needs of the people using services and a requirement has been made for this to be addressed. Current bathing facilities across the three floors are none on the second floor, one shower on the first floor and three showers on the ground floor. The information received confirmed a number of people using services are frightened and distressed by the experience of taking showers. Whilst the homes management generally promotes safe working practice some shortfalls were identified and are detailed in the body of this report in the quality area entitled Management and Administration. Having fully discussed these with the manager we are confident in her commitment to making the necessary improvements. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 9 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 Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to enable an informed choice of home and comprehensive needs assessments take place before admissions to be certain of the homes capacity to meet individual needs. Service provision does not include intermediate care. EVIDENCE: The statement of purpose had been recently updated and revised. A minor amendment is necessary to this document to reflect the reduced number of places following recent structural alterations to the premises. The statement of purpose contained clear service aims and objectives based on quality care principles and the homes charter of rights. The latter set out the standard and quality of service provision that management aspires to. Also the rights of people using services to an individualised approach to their care, based on Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 11 needs and choices, giving people using services as much information as possible to enable informed choice. It also addresses the six strands of diversity. The statement of purpose is included in an information pack. It was stated by the home manager that the pack is given to the relatives or representatives of people using services, usually when they visit to look round the home. The home manager confirmed work in progress on producing an up to date service users guide to insert in the information pack in due course. Discussions with some visitors during the inspection confirmed not all could recall receiving the pack or a copy of the homes statement of purpose. It is suggested that the home manager review systems for ensuring this information is always offered to enable an informed choice of home. It is suggested the pack also guides relatives and representatives of prospective people using services on how they can access a copy of the homes latest inspection report. Admission referrals are accepted from people funded and referred by social services or primary care trusts and from people who self – fund their placements. The home is efficient at obtaining copies of needs assessments carried out by social care teams and NHS funded care teams. On the basis of this preliminary information the homes management or senior nurses will then arrange to visit applicants to carry out a comprehensive pre-admission assessment, to be satisfied that needs can be met. The admission criteria is clear that the home will not consider referrals for people with challenging behaviours of such severity or frequency that they present an immediate risk to self or others or who present risks so serious they require access to an urgent and skilled response at all times. The admission criteria and preadmission assessment practices had been further developed and were more robust than at the time of the last key inspection. Admissions are on the basis of a three-month probationary period. On rare occasions this can be extended a further three months. Social Services normally hold a review after the first six weeks following admission. Avens Court will consider emergency admissions however insist on following the same pre-admission assessment procedure, which is applied even for referrals for people not living in Surrey. The home aims to provide an unhurried admission process giving relatives and representatives of prospective people using services time to visit the home, ask questions and discuss their plans. This is encouraged prior to assessment. However, this is not always within the direct control of management. A visitor gave feedback that her mother, who had lived at the home for one month and was in the process of being moved by her family to another home, had been Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 12 admitted to Avens Court without any choice of home. She said the hospital discharge process had been rushed after her visit to view Avens Court without offering other options to enable comparisons between homes and choice of home. She subsequently made a complaint in this matter to the social care team. She expressed frustration that whilst it was her choice to be moving her mother to another home so soon after admission, for reasons she considered to be in her best interest, she strongly expressed the view this situation could have been avoided if she had time to compare homes. Discussions with other visitors confirmed others who had not received opportunity to make an informed choice of home. Positive feedback was received from another relative of a person recently admitted. He expressed satisfaction with pre-admission procedures. He had received details of this home and a couple of others from a care manager and said he had been happy to be guided by the professionals on the right choice of home. When he visited Avens Court his contact with staff gave him confidence that staff knew what they were doing and he was impressed by their caring approach. He visits Avens Court four times a week and stated that so far he was very satisfied with the service and his observations. Discussion also took place with a person recently admitted for short-term care as an emergency admission when his carer was unexpectedly admitted to hospital. He was consulted in the presence of his son who was visiting him at the time. His son said that the home manager had promptly organised a preadmission assessment visit to ensure his fathers needs could be met. He was pleased with how well the home had responded to his fathers needs, including cultural and diversity needs, which he credited his fathers speedy adjustment to his new surroundings. His father stated that he liked the home and the staff, some of whom are of the same ethnic background as himself and talk to him at times in his first language. His son explained that there are times when his father reverts to speaking in his first language when he recalls the past. He expressed opinion that the staff at Avens Court had a good approach and understanding of the needs of people with dementia. The home does not provide intermediate care therefore this standard was not assessed. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 7,8,9,10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The health and personal care people using the homes service receive is based on their individual needs and medication is safely managed. Principles of respect, dignity and privacy are put into practice in the delivery of care. EVIDENCE: Nurses and care staff are deployed, where practicable, in the same living units, working under the direction of a two clinical senior nurse team leaders. Observations and discussions with staff and visitors confirmed the division of staff into two teams had overall positive benefits for people using services. Staff said this arrangement had enabled them to get to know the people they care for as individuals. Their understanding of non-verbal forms of communication had been enhanced, enabling a person-centred approach to care. Staff were observed using a communication board to establish the wishes of a person who is profoundly deaf. Changes to the building had created areas where people could sit in peace and quiet and others in more stimulating areas. The atmosphere of the home was overall calm, creating a positive dementia care environment. A relative commented that the dementia training Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 14 received by staff had much improved their approach and understanding of her husbands needs. Decisions for allocating people to unit and groups are based on individual needs and not influenced by the location of bedrooms. Individuals occupying first and second floor rooms could be seen seated in ground floor lounges (Orchid unit) during the day, or sat in their rooms, on the basis of their needs. Orchid unit is more suited to meeting the needs of individuals who are actively mobile or require a more spacious environment. The lounge in Lily unit, on the first floor, is used for people accommodated in first and second floor bedrooms who are mostly non-ambulant. Fifty-three people were accommodated at the home on the first day of the inspection. Observations confirmed mostly good attention to the personal appearance of those observed and their clothing was appropriate to their culture and age. During the visits staff were observed to respect the privacy and dignity of those in their care. Examples of good practice included staff knocking on bedroom doors before entering. Also a care assistant stood outside a toilet door giving the person inside opportunity for privacy, whilst at hand to provide the necessary assistance. The staff member was also noted to prevent other staff from intruding on this individuals privacy. It was evident, based on all observations, that the home manager and her senior team are committed to sustaining the benefits of staff training. This was being achieved through a structured staff management and support programme alongside positive reinforcement set by their own good practice. Individual staff used appropriate touch whilst engaging with people using services, demonstrating skill and empathy in their response to their emotions and feelings. It was good to observe the standard practice of staff taking time to explain to people using services what they are doing before doing it. An individual who had lived at the home for some time commented, everyone here is so nice and they all help me People using services have access to healthcare and remedial services. Their personal and healthcare needs and dietary requirements were clearly recorded in the care plans sampled. A commercially produced set of documents for care planning is used, modified to suit the needs of the home. A visitor confirmed her involvement in the care planning process for her husband. A nurse with qualifications in both general and mental health nursing was employed by the home to spend one day a week auditing care plans and related records, ensuring these are maintained up to date. A concerted effort had been made for continuous improvement in record keeping practices, to improve legibility and use of language. Areas of discussion with management included end of life planning. The manager and a team leader have since made arrangements to attend a train the trainer advanced care planning course organised by a hospice. The missing persons forms had been accurately completed in the files Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 15 sampled. Though there is a record format for collating information about the life history, interests and the likes and dislikes of individuals, this information was not available or in sufficient detail on some of the files sampled. A falls clinic referral criteria had been produced since the last inspection. Additionally, the homes falls prevention strategy had been further developed with input from a professional from the NHS falls team who had offered advice and training in risk assessment. With the involvement of family members and relevant professionals, the home had just implemented use of assistive technological equipment (sensors) for three named individuals, to minimise the risk of falling out of bed. The need to incorporate use of this equipment in a fully agreed care plan was identified. We spoke with the homes link community psychiatric nurse (CPN) who called in to visit people on her caseload. She confirmed her visits to Avens Court were approximately once a month. The CPN spoke in positive terms about the improvement in standards of care and in the environment since the appointment of the current manager. This perspective was endorsed by a number of visitors during the course of this inspection. Feedback we received from relatives about service shortfalls were known to management and an action plan in place for improvement. These included attention to the laundry system in view of lost and damaged clothing in recent months and for maintaining inventories of clothing and personal possessions up to date. A visitor commented that it would be helpful if staff ensured timely communication with relatives when clothes need to be replaced or repaired. Staff had all received moving and handling training. Practice observations included their use of hoists. A system for individualised use of hoist slings was planned and additional slings were on order for this to be implemented. A standing hoist was broken and the home manager stated her intention to order a new one. Pressure sore risk assessments and use of equipment ensured a good record of pressure sore prevention. Good practice assessment and record keeping was noted for treatment of pressure sores, where these exist. There is an efficient medication policy and the home has a good record of compliance with regulations for the receipt, administration, safekeeping and disposal of medicines, including controlled drugs. Medication trolleys were securely stored in a new lockable clinical room. Whilst the storage facility for controlled drugs was limited in capacity, nurses stated this was adequate. The medication records sampled had been fully completed, containing required entries and signed by appropriate staff. New developments include secure storage of creams for external use and razors. Also for key workers to meet regularly with people they key work to record their observations and any changes. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been significant improvement in arrangements for meeting the social needs of people using services, appropriate to their needs, age and culture. Major shortfalls in catering standards and practice were identified and an action plan has since been put in place for improvement. EVIDENCE: Magazines and newspapers were available and staff observed spending one to one time with people using services in the various communal areas, using recall techniques and craft activities to stimulate conversation. A large flat screen television is available in one of the ground floor lounges and televisions and music centres available in other communal areas. The home manager is active in trying to find a resolution to the long-standing problem of the homes poor television reception. Consideration is being given to the installation of a satellite package for this purpose. A new DVD player and karaoke machine was purchased during this inspection. On the afternoon of one of the visits staff and a visitor were observed using the karaoke equipment for the pleasure and enjoyment of people using services, some of whom were humming and singing along to popular tunes from the forties and fifties and staff dancing with others. The lounge on the ground floor was very stimulating and staff took time afterwards to restore the former calm atmosphere, preparing people for Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 17 their evening meal and for bed. Visitors were seen in the home at all times of the day, across both visits. Staff engaged people using services sat in the dining room, library and first floor lounge, in quieter activities, with music softly playing in the background. The home was seasonally trimmed with a Christmas tree and decorations. Christmas social events at the home were publicised on notice boards and notices displayed in other public areas. Staff were encouraging and supporting individuals to make Christmas cards to give to their relatives and friends. The festive activity programme included a carol concert by a local primary school choir and a Christmas party with entertainer, to which relatives and friends were invited. The homes social activities programme had been further developed since the last key inspection, providing a combination of one to one and group activities. Two staff shared lead responsibility for coordinating the programme and was stated to have received relevant training from the Alzheimer’s Association. Observations confirmed care staff and nurses to be aware of their individual responsibility to ensure appropriate social stimulation for the people in their care. The home now has an identified social care budget that had been used to purchase activity resources. It was suggested this include additional activity equipment and materials to stimulate use of recall and reminiscence. A selfemployed activities coordinator had up until recently provided a musical based activity session on one afternoon a week. The manager stated this was shortly to resume. Plans to extend the programme to include community based, one to one activities were at an early stage. For this purpose risk assessments had been carried out for two people. The home was waiting for additional funding from care management to support this new development. The home does not have its own transport and the intention is to use wheelchair accessible taxis. Nurses had been trained to use a validated nutritional assessment tool and a system for monitoring weights was being maintained up to date. A four weekly rotating menu was standardised across the organisations group of homes. The menu was relatively new and there had been no opportunity for people using services to be consulted about its content. Observations confirmed the menu did not always lend itself to the specialist dementia nursing home environment of Avens Court. Though the menus do not afford a choice of meal, in practice this is provided and a record kept of the alternative dish. The new menus had cut out provision of desert with the evening meal. A cooked breakfast is provided three times a week. Catering standards, kitchen hygiene and working practices fell significantly short of the standard expected at the time of the first inspection visit. The need to supply catering staff with a list of individual food preferences was also identified. Though this information was sought on admission it was not used to inform catering staff or ensure people using services had a choice of food. Poor communication and poor interpersonal relationships between the cook and second cook, who was deployed in the role of kitchen assistant at the time of the first visit, had an adverse impact on teamwork. These issues were Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 18 long-standing and tensions exacerbated by a management decision preventing staff on their breaks from using the staff room to make hot drinks. Instead the kitchen was used by the large staff group for preparation of drinks and snacks and heating up food brought in from home. This situation was noted to be disruptive to the kitchens operation as well as a hygiene and safety risk. We received information that staff ignored the managers instructions for only two staff at a time to be in the kitchen and the cooks instructions not to use the kitchen as a route to the outside smoking area. It was evident that the cook had little control over his kitchen and his decisions and authority was being undermined by management decisions and by individual members of staff. This situation was clearly a contributory factor to cold pureed meals being transported to the first floor unit for lunch at the time of the first inspection visit. This does not explain however why care staff on that unit served these meals and began to assist people to eat the same, only stopping when we asked them to do so. This situation was then reported to management and the meals replaced. The manager was in the process of carrying out an investigation in this matter at the time of the second visit. Care staff were unable to offer any explanation for their actions. Concerns regarding the value base of these staff were discussed with the home manager. Also the cooks value base given the poor presentation and unpalatable taste of the pureed meal, even after heating. The cook acknowledged it was not his practice to taste the food prepared, despite having a catering qualification. It was noted that he stated this was not his usual standard of presentation of pureed food. Other shortfalls included failure to provide soft diets to meet the assessed needs of individuals or to ensure a varied diet for people recorded to eat only sandwiches. These individuals were not offered a cooked lunch or evening meal on both days of the inspection visits. On day one of the inspection they had a sandwich and yoghurt for lunch and reconstituted packet soup made with water followed by sandwiches for their evening meal. Whilst acknowledging they may not wish to have a cooked meal this still should be routinely offered. It was also noted that it was not the practice to fortify common foods such as soups and mashed potatoes though the home manager was under the impression this was the practice. Kitchen cleanliness was unsatisfactory at the time of the first visit. The floor was sticky and the kitchen disorganised throughout and evident that the cook and kitchen assistant were not coping with the workload. The dishwasher had a history of breakdowns and was understood to be in need of further parts to be fully functional. The oven thermostat was faulty, despite being recently repaired and the heated trolley used to transport food to the first floor unit was broken. The kitchen staff said they did not have sufficient cooking utensils and each had only one set of protective clothing. A senior cook for the organisations group of homes was deployed at the home at the time of the second visit. He was covering catering duties as the cook and kitchen assistant were both on leave and had been tasked to carry out an Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 19 audit in the kitchen. An action plan for improvement to shortfalls identified during this inspection had been drawn up. The home manager stated plans for a new dishwasher and staffing levels in the kitchen had been increased. The need for improvement in kitchen hygiene was discussed. It was noted that since the first visit maintenance work had been carried out in the kitchen and the fluorescent tube in the outside food storage area that was not working, had been replaced. Contact was made with the Environmental Health department in these matters during the course of this inspection. At the time of the second visit the standard of catering had much improved. The heated trolley for transporting meals to the upstairs unit had been repaired and was in use. On this occasion, however, whilst the cook had prepared ample quantities of a tasty treacle sponge and custard the people on this unit were not offered the same and all given yoghurt. Staff who went to the kitchen to collect the deserts had helped themselves to the yoghurts. We drew this to the home managers attention and action taken to offer people on this unit an alternative desert of fresh fruit salad. The manager has since confirmed that a copy of the days menu is now recorded on the orientation board in this unit so staff are aware and offer the meal choices. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using services are overall protected by the homes policies and procedures. They and their representatives benefit from knowing the home takes all complaints seriously and use them to improve services. EVIDENCE: The home has a written complaint procedure that meets the national minimum standards and regulations and is easy to understand. The statement of purpose makes reference to the procedure and the home manager said a copy is issued to the representatives of people using services on admission. The procedure was displayed on the notice board by the front door, partly obscured by other notices. It was suggested this be displayed prominently in the reception area also in other public areas. The complaint records sampled contained a record trail of complaint investigations and of action taken, where necessary, for improvement. The home manager evidently takes complaints seriously and written outcomes of investigations had been sent to complainants. Visitors said they could discuss concerns and complaints with the home manager and were confident these would be appropriately dealt with. We received two complaints about the home since the last key inspection. These were referred to the safeguarding team and incorporated into current safeguarding adults proceedings, as were several of the complaints recorded in the complaint record. With the agreement of the safeguarding chairperson the home manager had carried out these investigations and implemented changes for improvement. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 21 The homes safeguarding adults policy and procedure integrates with the local multi-agency procedure of which the home has the latest edition. There is a clear system for staff to report concerns about colleagues and managers and the homes policy makes clear to staff that the service supports those who blow the whistle on bad practice. Discussions with staff confirmed they are informed of the homes safeguarding procedure and had received relevant training. The home manager understands the procedures for safeguarding adults and will always attend meetings and provide information to external agencies when requested. Incidents being investigated under safeguarding procedures at the time of the last key inspection and others have been the subject of protracted safeguarding adults proceedings throughout the past twelve months. The homes management has fully cooperated in these matters. Seven senior strategy meetings have taken place. Social Care Teams have reviewed the care of all people using services. The homes management agreed to commission an independent investigator for an independent investigation into other safeguarding issues and has been compliant with the investigators recommendations for improvements. Professionals with an interest in the home are continuing their contact and collectively are satisfied with improvements. Arrangements are in place, with the agreement of the home manager, for a named professional to provide short-term monitoring and support to Avens Court. The home manager spoke positively about the benefits of this to people using services. A shortfall in staff vetting procedures outside of the home managers direct control was identified through the efficiency of new systems being implemented by the manager. Appropriate action had been taken with immediate effect to ensure the safety of people using services. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 19, 21, 22, 25, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Modifications to the premises and attention to décor and signage have substantially enhanced the care environment and had a positive impact on care practice. Problems with the heating system persist despite remedial work and continue to receive attention. Shortfalls in bathing facilities must be addressed. The home was clean and comfortable and odour control generally well managed. EVIDENCE: The inspection visits incorporated a tour of the building, sampling bedrooms and en-suite facilities. All communal areas were viewed, also the garden, kitchen and food storage areas and laundry facilities. The environment was overall comfortable, safe and mostly well maintained. Since the last inspection work had taken place, dividing communal living areas into two units. Orchid unit is situated on the ground floor and Lily unit occupies both the first and second floors. Two adjacent twin bedrooms on the first floor had been Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 23 converted into a communal lounge. A partitioning wall between these rooms had been removed and they had been conjoined with an archway, creating a homely setting. A major upgrading, refurbishment and redecoration programme was nearing completion since the time of the last key inspection. The dividing partition separating the dining area from the lounge in Lily unit, also the provision of the lounge on the first floor had achieved a generally calmer, more suitable environment, reducing distractions and background noise. The new doorbell with a softer tone had also contributed to the reduced noise levels. An individualised approach based on needs is taken to whether people are cared for in their bedrooms or communal areas during the day. Colour and cues provided by décor, fittings, new carpets and photographs have had a positive impact on the experience of people living in the home, aiding orientation. The homes management has used researched best practice design principles to enhance the environment and improve signage. White boards are provided in the ground floor dining room and the first floor lounge with information recorded to aid orientation. A large faced clock is positioned in the entrance hall. Consideration should be given to providing additional large faced clocks in other communal areas, to aid orientation in time. The home was clean and tidy and overall odour was well controlled at the time of both visits. The home manager was proactively trying to resolve the long-standing poor television reception at the home and considering the installation of a satellite package. Deficiencies in heating in parts of the home remained problematic, though some improvement noted with the replacement of two boilers since the last key inspection. Heating engineers continue to have input to rectify variations in bedroom temperatures and were in attendance during one of the inspection visits. Bedroom temperatures are monitored and recorded by staff on a daily basis. A requirement was made for shortfalls in bathing facilities to be rectified in the best interest of people using services. The parker bath on the third floor was not working and the bathroom on the first floor was in a poor state of repair and the bath unusable. Bathing facilities do not meet the needs of the people using services and a requirement has been made for this to be addressed. Current bathing facilities across three floors are none on the second floor, one shower on the first floor and three showers on the ground floor. The information received confirmed a number of people using services were frightened and distressed by the experience of taking showers. Attention is also necessary to the new dining tables a number of which were unstable. Work was in progress to improve the safety of the ramped access to the garden following an assessment by a qualified occupational therapist. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in staff recruitment and vetting procedures were identified during this inspection by new systems being implemented by the homes management and action taken to minimise risk. People using services benefit from a suitably trained and skilled care team, sufficient in numbers to meet their individual needs. Shortfalls in catering staffing levels have since been rectified. EVIDENCE: Staff work in two teams under the direction and leadership of two clinical team leaders who are both registered nurses. The homes statement of purpose states the home employs six registered general nurses, four registered mental health nurses, four health care assistants with a National Vocational Qualification in care (NVQ) Level 3, nine health care assistants with NVQ Level 2 and fifteen health care assistants working towards attaining NVQ levels 2 or 3. The staff rotas sampled confirmed at least two nurses on duty throughout the waking day, some days up to four nurses, additional to the home manager and deputy manager. Thirteen care assistants were on duty at the time of the visits also two members of housekeeping staff, a cook and kitchen assistant. An administrator is also employed. Maintenance staff employed work across the organisations group of homes. The home manager stated that night staffing levels had increased and comprise of one nurse and four care assistants. Observations confirmed a good staff presence in all communal areas throughout the visits, ensuring adequate observation. On the basis of all Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 25 available information it was concluded that staffing levels for nurses, care staff and housekeeping staff was adequate and consistently maintained. Catering staffing levels were not adequate and have since been increased. Nurses and care staff wore clean, practical uniforms and identity badges. Shift planning records were clear in the deployment and allocation of duties and responsibilities for all staff. The home had successfully recruited additional nursing staff since the last key inspection. The home was benefiting from the recent employment of care assistants with professional nursing qualifications obtained overseas. Though not registered to practice as nurses in the UK they possess relevant transferable skills and knowledge. In discussion with one of these care assistants it was noted that it was her first day on the rota, providing care and support to people using services. She was shadowing an experienced care assistant who was explaining the routines and individual needs of the people in their care. Prior to this she had undertaken a five - day induction, this programme incorporating statutory training also dementia training provided by Age Concern. Observation of records confirmed a comprehensive staff induction programme signed off by the home manager. The home manager stated her intention for existing as well as new staff to undertake the new induction programme. Staff recruitment and vetting practices are carried out centrally at Surrey Rest Homes head office. A new development at Avens Court was the recent appointment of an administrator. She had been requested by the home manager to reorganise staffs files held at the home, removing Criminal Record Bureau (CRB) disclosures from these files, in accordance with CRB policy. During the course of this activity it was identified that two staff members in post for some years did not have CRB disclosures. The home manager took immediate action for these staff to apply for the same and in the interim, until checks had been carried out against the national register of staff unsuitable to work with vulnerable adults (POVA list), they refrained from work. Observations of the personnel files sampled identified other shortfalls in recruitment practices. Prior to the appointment of a care assistant, she had undertaken a practice placement at the home as part of a care qualification course, without the organisation first carrying out a CRB and POVA check. Discussion took place with the home manager who is contemplating student nurse practice placements at the home in the future, confirming the requirement for CRB and POVA checks to be carried out and repeated for each student placement. The need to maintain a continuous CRB record for the whole team was discussed and for compliance with the CRB policy on recording, storage and disposal of disclosures. It was evident from the information received that the organisations head office is not efficient in its systems for carrying out CRB checks and recruitment practices need to be improved. The checklist used for recruitment purposes needs to be more comprehensive and a system in place for monitoring the renewal dates for nurses pin numbers, enabling them to continue to practice. The home Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 26 manager is involved in interviews and was clear that the job specification requires applicants for care assistant posts to be competent in their command and comprehension of the English language. A care assistants file sampled however contained a references that clearly stated her communication skills had been poor however the decision taken to offer her the post. The home manager was unaware of this reference and not thought to have been involved in this appointment. The home manager reported that the language skills of this staff member had significantly improved. Copies of job descriptions were seen on the files sampled and of staff contracts. The manager was requested to ensure the cook has a job description, as the one on his file was not relevant to his current post. The homes training plan confirmed a relevant programme of staff training taking place. With the exception of very new staff, all others had received dementia training since the last key inspection. Discussions with individual care staff on how they were applying new learning to practice, confirmed their enhanced understanding and insight into the experiences and preferences of the people in their care. The training had served to heighten awareness in staff that each person experiences dementia differently. It had equipped staff with knowledge and skills to enable choices in the daily lives of people using services. Other training had raised awareness to ways to create a positive and safe environment for people with a visual impairment. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 31, 32, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a qualified and competent registered manager. Quality assurance systems exist and the views of the representatives of people using services are listened to. Substantial improvement has been achieved in a number of areas of the homes management and operation. The manager is aware of shortfalls in staff recruitment and vetting practices, catering, the supervision of meals and in bathing facilities and committed to taking remedial action within her direct control. EVIDENCE: The homes atmosphere was found to be friendly, warm and welcoming. Positive relationships exist between individual staff members and individuals using services, also their relatives and visitors. Since the last inspection the home manager has been registered and she was on duty at the time of the visits. The home manager is a mental health nurse, Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 28 qualifying in 1986 and has attained the registered managers award qualification. A new development had been a change in the homes management structure that now includes a deputy manager who has been promoted from the post of team leader. She has qualifications in both general mental health nursing. The senior team includes a clinical nurse team leader and acting clinical nurse team leader, senior staff nurses and nurses. Observations suggest a cohesive management team with clearly defined roles and responsibilities. The manager demonstrated a clear understanding of the principles and focus of the service. These are based on organisation values and priorities and take into account the changing needs of people using services. Based on the available information it was concluded that the home manager promotes equal opportunities in the operation of the admission criteria and recruitment and management of staff. She has good people skills and understands the importance of person centred care. She is aware of where further improvements can be made and is working to an improvement agenda. A further recent development has been the appointment of an administrator whose office is sited off the front entrance hall. She has relevant experience in the hospitality and service sector and demonstrated excellent customer services skills in her contact with the public. The manager expressed how much she and her senior team had benefited from her efficiency, also from their reduced responsibility for answering the telephone and the front door. The administrator was observed to empathise and have a good approach in her contact with people using services and visitors to the home. Areas of discussion with the home manager included the need for the responsible individual to apply for variation of the homes conditions of registration to accurately reflect the reduced number of places. The statement of purpose needs to be amended accordingly. The home must produce a service users guide and the home manager stated this work was in progress. Shortfalls in staff recruitment and vetting procedures are currently not within the managers direct control. That said, the manager is responsible for implementing a systems to ensure the rigorous vetting of new staff in future before taking up post. The home has a clear health and safety policy and risk assessments are carried to ensure safe working practices. Maintenance staff work closely with the homes management to reduce hazards, where identified. The need to carry out a risk assessment in respect of the hazard posed by the trailing electrical flex of the vacuum cleaner when housekeeping staff vacuum the main staircase was identified. Consideration may need to be given to additional electrical sockets to reduce this risk. Attention was also drawn to the potential hazard posed to people using services by the television in the first floor lounge precariously balanced on a small table. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 29 A random sample of staff training records confirmed they had received relevant training to ensure the health, safety and welfare of people using services. Since the last inspection, staff other than three new care assistants had received fire marshal training. An action plan had been agreed with the Surrey Fire and Rescue Service for carrying out essential work for compliance with The Regulatory Reform (Fire safety) Order 2005. The home manager confirmed this would have an impact on and change the fire evacuation procedure, in due course. Further training will be taking place for staff once evacuation pods and sliding sheets for under mattresses have been obtained. The home manager confirmed that most bedroom doors need replacing for compliance with fire safety regulations. The current practice of wedging bedroom doors, in the interim, for maintaining adequate observation of people nursed in bed, should be discussed with a fire officer. The home maintains accident records and we are now being notified of significant events. The home has an efficient system for the secure storage and administration of personal money left for safekeeping by relatives. These records were sampled at the time of the visit. Quality assurance systems include a forum for the relatives and representatives of people using services to meet with the home manager and their feedback is valued and listened to. Audit systems are in place also monthly statutory visits made to the home by a senior manager, external to the homes management, in accordance with the regulations. A quality survey has been carried out, to obtain feedback from representatives of people using services. These were viewed and overall demonstrated satisfaction with service provision. Comments included, Good service, all staff seem satisfactory, caring and polite, The manager Sarah has improved things greatly, I have been asked to sample the food, did so and was satisfied, Staff are first class, They are all extremely caring and they keep cheery, upbeat attitudes even with residents who are difficult. They listen to you, I was unhappy with the bed and they changed it. Comments for improvement included, Food could be warmer, Bedroom could do with a drop of paint, critical about odour, Mums clothing not as clean as I would like. Also would like the curtains open more during the day. Discussion with the manager confirmed survey feedback for improvements had generated action, though not recorded. A broken chest of drawers and grubby wicker chest of drawers had been replaced. It was suggested the manager record the analysis of quality surveys and produce an action plan for any necessary improvements, maintaining a record of the action taken. The manager should also consider ways for including people using services in this process. Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 30 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 1 x 4 3 3 N/A 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 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 1 x x x 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 2 Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 31 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 OP21 Regulation 23(2)(j) Requirement For facilities to include sufficient baths and showers suitable to meet the needs of people using services. Timescale for action 12/04/09 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 Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Avens Court Nursing Home DS0000066356.V373164.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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