Care Home: Avenue House

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What the care home does well The home has an area for residents, near to the main entrance, to rest and make drinks for themselves. This area also contains a notice board which had a range of information available for residents to use. This home has several volunteers who are involved in supporting residents. The way the home incorporates volunteers into its service is commendable. The residents in this home are made aware of the complaints procedure and would be provided with help and support if they had to make a complaint. What has improved since the last inspection? Residents have a new range of meals to choose from and the choices are more clearly set out. Residents should find that the complaints procedure is now easier to follow. What the care home could do better: Potential residents can get enough information from the home to help decide whether the home is right for them. However the Service User guide one of the sources of information to help make the decision did not have all the information required by the standards. New residents moving into the home would receive consistent individualised care sooner if their care information, collected at assessment, was written into their care plan. CARE HOMES FOR OLDER PEOPLE Avenue House 5 Cotham Park North Cotham Bristol BS6 6BH Lead Inspector Savio Toson Unannounced Inspection 09:00 30 October 2007 th 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 Avenue House DS0000026495.V350390.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. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avenue House Address 5 Cotham Park North Cotham Bristol BS6 6BH 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) 0117 9892020 0117 9892059 West of England Friends Housing Society Limited Mrs Caroline Cooper Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 30. 26th April 2007 2. Date of last inspection Brief Description of the Service: We have registered Avenue House to provide accommodation and personal care for up to thirty service users (residents), aged sixty-five and over. The Home is an older style detached property, with a large modern extension to the side of the house. Avenue House is situated near the city centre in an established residential area near to parkland. Public transport is available within a short distance of the home. Local shops and community facilities are within half a mile of the Home. The home has several lifts and all floors are accessible for wheelchair users apart from the basement. The Home has mostly single bedrooms except for two, which lets couples share if they wish to. All of the bedrooms are en-suite. Weekly fees (as at October 2007) range from £452 to £539 a week. Fees include all care and accommodation costs, meals, laundry and activities. Additional charges are made for hairdressing, chiropody and other items listed in the service user guide. People are expected to pay for their own personal items such as private telephone, toiletries and newspapers. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over 6 hours and was completed in one day. I worked with evidence from a whole range of different sources, including: • Information provided by the manager in the pre-inspection questionnaire • Information taken from nine resident survey forms (with some residents assisted by their relative.) • Information from resident’s relatives who filled out a survey form. • Information from two professionals who visit the home • Speaking with nine residents • Speaking to two visitors • Case tracking a number of residents • Speaking with seven care staff • Walking round the home • Examination of some of the homes records • Observing how staff support and work with the residents. The overall analysis is that the home is a good place for people who use the service and the recently appointed manager shows commitment to continuing to make improvements to the service. What the service does well: What has improved since the last inspection? Residents have a new range of meals to choose from and the choices are more clearly set out. Residents should find that the complaints procedure is now easier to follow. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 1,3 but not at standard 6, as the home has no intermediate beds. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents are given sufficient information to see if the home is suitable for them. Potential residents move into the home knowing that their assessed needs can be met. EVIDENCE: Potential residents are given sufficient information to see if the home is suitable for them. The statement of purpose was on the notice board near the entrance and contained all the required information. The statement contained the fees and the costs which the resident had to pay. The service user guide, which was another source of information for residents, did not have sufficient details about relevant qualifications and experience of the staff. The notice board contained a range of information which gave a potential resident an understanding in how the home is run. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 9 Potential residents move into the home knowing that their assessed needs can be met. The residents are assessed and the records showed that information was collected which included the resident’s individual needs. One care record described how the resident drank tea with honey and a biscuit. This was an example of the detail the staff went into, to ensure residents were treated as individuals. Other assessments included the skin condition of the resident, and the resident’s ability to move. With the manager not being in the home at time of inspection the issues equality and diversity will be further explored at the next inspection. However the self assessment returned by the home said: “Whilst a Quaker based home, we promote our services for all people according to entirely need. We have a clear and detailed Equal Opportunity policy as well as various other policies, including a harassment policy aimed at ensuring service users and staff are free from discrimination and cultural differences are respected. Diversity and Equal Opportunity training is available.” Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Established residents have care plans which describe how their needs can be met. Some new residents do not have the information collected at assessment, written into their care plan. Residents keep contact with other health services when required. Residents can expect to have their rights and privacy respected. EVIDENCE: Established residents have care plans which describe how their needs can be met by the staff. The planning of how care was to be provided by staff, included information on religion, personal care, nutrition and health promotion. Changes to the resident’s health and welfare had been recorded and gave guidance to staff on how to meet the residents changing needs. However another care plan, which contained a lot of individual information collected at assessment, did not have the information written into the care plan. There was also insufficient information in another care plan for a person recently admitted into the home. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 11 Residents keep contact with other health services when required. A care plan included the recording of visits from professionals from other services. On the day of inspection two district nurses were visiting and both were complementary about the care the staff gave to residents. WE discussed the quality of the care given by the staff and how it was good, which meant no one in the home had any pressure ulcers. The two professionals surveyed by us who returned their forms, spoke well of the home. Residents live in a home where they are given medicines safely by staff who follow the home’s medicine procedure. The medicine administration sheets viewed were in good order. The home had a medicine administration policy and procedure which staff could access. The controlled medicines book was checked to ensure staff were following the administration of medicines procedure and that the balance in the book was the same as the amount of medicines stored in the cupboard. Residents can expect to have their rights and privacy respected. Staff were observed talking to residents in a decent polite way. Residents and relatives we surveyed said the staff were “ friendly, and created a nice atmosphere”. Another resident said” I am left to live my life the way I want to live it”. Another said the staff were “very kind”. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 12 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 were viewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered a range of recreational activities. The home has a significant number of volunteers prepared to help out in the home. Resident’s view of the meals varies but they do have choice of meals. EVIDENCE: Residents are offered a range of recreational activities which include artwork, music, knowledge quiz and exercise classes. The diary of events was on the notice board and on the day of inspection, residents were working on greetings cards in the activities room assisted by a voluntary helper. Residents are in regular contact with volunteers who help out in the home. Volunteers have the relevant security checks made on them, before working in the home. The volunteers assist with running the recreational activities. The residents can use an area near to the front entrance for their recreation. The area on the ground floor has seats and sufficient circulation space for wheelchair users. Residents can make themselves drinks, read books and use the notice board. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 13 Resident’s relatives are included in the running of the home and the most recent relatives meeting was held in mid July. I was able to read the minutes from this meeting. Relatives who answered the survey said that that staff kept them informed of their residents changes. One resident’s surveyed said they would like more contact with what is going on in the home. The self assessment returned by the home said: “Monthly Resident Meetings are held, Resident satisfaction Surveys is conducted by an independent external company, Relatives meetings have been introduced and are being held twice a year. Resident meetings are held each month. Diary of Events meetings are held monthly.” Residents described how they exercised choice. “ I can choose what to do more or less”. A resident explained how they choose their bedtimes. Residents are offered a choice of food. The alternative choice to lunch is a vegetarian and hot snacks are served in the evenings. The menus viewed offered a variety of meals. One resident did not see the vegetarian option as a choice. Another resident surveyed said they would like the menu changed but this was written before the menu was reviewed in September 07. Other residents spoke well of the food, all of those who responded said it was “fine of good. (or) can’t please all of the people all of the time”. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 14 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 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can feel able to make a complaint and get the help to support them if they need it. Residents live in a home where staff understand the need to ensure residents feel protected. EVIDENCE: Residents can feel able to make a complaint and get the help to support them if they need it. The notice board contained a range of information which could help residents who wanted to express concerns or a complaint. There was information from “age concern”, the local authority’s “ no secrets” booklet, and how to arrange for an advocate for assistance. The residents had access to a complaints procedure which was well written and easy to follow. The 9 resident’s and relative’s surveys returned to us all said they knew how to make a complaint. Residents live in a home where staff understand the need to ensure residents feel protected. The protection of vulnerable adults procedure was on display on the notice board. Two staff interviewed could describe the action they would take if they suspected abuse. The home also had a whistleblowing policy for staff to follow if they suspected any resident was being abused. The self-assessment returned by the home said: Our compliments, complaints and comments system is advertised and leaflets are available. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 15 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 19,23,24,25,26 were viewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home which was found to be warm, clean, tidy and well light. The home was also well maintained. EVIDENCE: Residents live in a home which was found to be warm, clean, tidy and well light. The home was also well maintained. The residents who gave their views during the site inspection all expressed a high level of satisfaction with their room and felt they were able to make it their own. Residents have their clothes laundered on site. Several items of clothing which had just been laundered were checked and found to be clean, fresh smelling and stain free. The home had an infection control policy. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 16 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. Residents live in a home where there is a range of staff working in the home to ensure a good service. Residents live in a home where staff receive training. EVIDENCE: Residents live in a home where there is a range of staff working in the home to ensure a good service. The home employ care staff, domestics, catering, maintenance and administrative staff. The staff interviewed said that they were kept busy when working in the home but did not feel rushed. Residents did not say that staff were rushed. One resident who was asked if there were enough staff on duty responded “ oh good gracious me, yes”. Residents who filled out the surveys expressed concern about the turn over of staff in the home but only seven agency staff were used by the home in October. This meant, most of the care was provided by the home’s own staff. Residents are cared for by staff who were recruited and had their safety checks carried out. The personnel files viewed of staff recently recruited by the home contained the required employment information and the required safety checks had been carried out. It was also an opportunity to view the training information which showed staff recruited into the home had been keeping themselves up to date. And this was supported by staff who were interviewed as part of the inspection process. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 17 Residents live in a home where staff receive training. Staff said that had received training in manual handling of loads, fire training, food hygiene and health and safety. The main training records were not available for inspection because the manager was away and her office was locked. The training records should be available at inspection so this has become a legal requirement. However the self-assessment sent in by the home said: We currently have 60 of NVQ trained staff whilst we also have 4 members at present undergoing their training. We have a comprehensive recruitment Manual which sets out clear guidelines. Supervisions are held frequently and used as a tool to develop staffs’ skills. All Statutory training has been held for the year. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 18 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 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home where they feel part of the home. The residents are supported by a friendly staff team. Residents live in a home where safety checks on the building and equipment have been carried out. EVIDENCE: Residents feel part of the home. The residents are supported by a friendly staff team who were observed on the day of the site inspection working well alongside the residents. Also both the resident’s surveys and those who shared their views on the day of the site inspection spoke well of the staff and manager. One resident said they would want to see “nothing changed in the home”. Whilst another said “the manager is a friendly person and there have been changes but I’m very happy here”. The self-assessment returned by the home said: We deliver a service according to the residents’ needs and wishes. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 19 Resident’s input into the home is invaluable. The home has strong links with the community and has a good reputation for providing quality care. We believe we respect and value each individual, and work in a truly person centred way and focus on meeting the spiritual needs of residents. The residents described their life in Avenue House as if it was their home and all I meet were pleased with the service. Residents live in a home where staff have a range of policies and procedures which are available for them to follow when providing care to residents. Residents take care of their own day to day financial affairs. Residents receive a service which is monitored and audited to ensure quality is maintained. The service is regularly audited and the residents are surveyed to get their views of the service. The Manager carried out the most recent survey on the 7 April 2007, which contained a range of customer satisfaction questions and positive responses.(as per June 2007 report) Residents live in a home where safety checks have been carried out. The quality self-assessment provided the dates of when equipment and utilities were checked. These checks and servicing of equipment were up to date. Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 20 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 2 X 3 3 X 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 3 3 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 X 3 3 Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 21 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 OP1 2 OP7 15(1) Standard Regulation 5(1)(a) Requirement The service user guide needs to include the relevant qualifications and experience of the staff working in the home. The care records of recently admitted residents recently admitted into the home need to include completed short term care plans Training records which form an essential part of the inspection process need to be made available even when the manger is off the premises. Timescale for action 01/01/08 01/01/08 3 OP37 17(3)(b) 01/01/08 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 Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Avenue House DS0000026495.V350390.R01.S.doc Version 5.2 Page 23 - 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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