Care Home: Avenue House

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What the care home does well The home makes every effort to provide people with a good care to meet their assessed needs following a care plan. The home has a good key worker system and staff supervision system in place. The home communicates well with the families, friends and representatives of people who use the service and welcomes visitors. People who use the service say they are happy and content with living in a homely and caring place. The home provides a relaxed, comfortable and friendly atmosphere where people are treated with respect and in a dignified way.People who use the service are often vulnerable both physically and emotionally and the Registered Provider/Registered Manager ensures that staff recruited have the ability to carryout personal care services for people sensitively and tactfully. The recruitment of good caring staff is critical to the running of care homes and the Registered Provider and the Registered Manager at Avenue House undertakes this carefully. The home has a good staff training and development programme in place. A majority of staff have received mandatory training in safe working practice topics, Dementia care, safe handling of medication and NVQ Level 2. Thus training will ensure that the staff have improved their knowledge and skills to meet the changing care needs of people who use the service. The home provides good standard of accommodation and facilities for people using the service. What has improved since the last inspection? Two requirements out of three and one recommendation out of two have been implemented by the home. The home now has a Registered Manager in post and she is embarking on gaining the required qualifications. Conversations with staff, people who use the service and their relatives, indicated that the Registered Manager is service user focused, leads and supports an enhanced staff team providing them with improved training and supervision. This style and approach to management aims to pursue future improvements in all aspects of service. One person who live at the home stated that "This place is a lot more peaceful and better organised". The home has made good improvements in their recordkeeping and care planning. Care Plans seen for people who use the service were informative and gave some indication of how care is to be delivered for each of them. Medication practices have improved and more staff have received training in safe handling of medication. All staff with the exception of two have completed their training in Dementia care and that will enable them to expand their knowledge and skills and enhance the care they give to people using the service. It was noticeable that there have been many improvements made to the environment of the home along with the recent application for variation of the conditions of registration for initially six places for people with Dementia care needs. A rolling programme of redecoration has been implemented, and communal areas have been redecorated. The garden and patio areas at the rear of the premises have been improved and made accessible and secure. Appropriate locks have been fitted to all the bedrooms. A suitable and safe sheltered space has been provided for people using the service who wish to smoke. What the care home could do better: The home must continue to improve further the detail and quality of daily care recordings. The introduction of a more appropriate and suitably structured programme of social and leisure activities after consultation with people living at the home would really improve further their quality of life and help maintain close links with the local community by people who use the service. Those members of staff who as yet have not received training in safe working practice topics, safe handling of medication, NVQ Level 2, Adult protection and safe guarding issues must do so as a matter of priority. This training would enable staff to improve further their care practices and professionalism. Review and increase in ancillary staff will assist in enhancing the staff team and improving the quality of care for people who use the service. Swift action should be taken to fully complete the quality Assurance monitoring for the Year 2007. CARE HOMES FOR OLDER PEOPLE Avenue House Avenue House 26 Clifton Road Tettenhall Wolverhampton West Midlands WV6 9AP Lead Inspector Bhag Jassal Unannounced Inspection 22nd November 2007 09:27 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 DS0000064388.V352433.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 DS0000064388.V352433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avenue House Address Avenue House 26 Clifton Road Tettenhall Wolverhampton West Midlands WV6 9AP 01902 774 710 01902 77 47 12 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) West Midlands Residential Care Homes Ltd Michelle Marie Simmons Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered as a care home for older people subject to the provider meeting the Conditions of Registration in Appendix 1 dated 17/6/05. 2nd March 2007 Date of last inspection Brief Description of the Service: Avenue House care home provides personal care and accommodation for 21 older people. The home is situated within a short distance of Tettenhall Village where the amenities include a post office, shops and a public house. Avenue House is a large detached Grade 2 listed building approximately 145 years old. The home stands in two and a half acres of lawns and woodland. The home has been completely refurbished, adapted and recently extended for its present use as a residential care home for 21 older people. There are two double bedrooms and 17 single bedrooms, four of which have en-suite facilities, two lounges, a dining room, laundry, kitchen, staff room and Registered Managers office and a staff training room. There is a large car park and very attractive garden and grounds. The present Registered Individual Mr Hareendran Balasubramaniam (on behalf of West Midlands Residential Care Homes Ltd) has been operating this service since July 2005. The Registered Manager Ms Michelle Simmons was appointed as an Acting Care Manager in October 2006 and then she was registered in March 2007. West Midlands Residential Care Homes Ltd makes their services known to prospective service users in the Statement of Purpose and Service Users’ Guide. The Inspection Report is mentioned in the Statement of Purpose and how a copy can be obtained. The care home charges (fees) are reviewed annually and people who use the service are notified one month in advance. The only additional charges to people who use the service are for hairdressing, toiletries and chiropody. This is clearly laid out in the home’s terms and conditions. The current fees charged at Avenue House, as stated in the Service Users’ Guide, range from £337.00 to £410.00 per week. All people using the service pay monthly. Up to date information about fees is obtainable from the manager. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is on a Key Inspection, part of which included an unannounced visit undertaken on 22nd November 2007. This unannounced visit started at 09.27 am and lasted 8 hours and 18 minutes. The home had 14 places occupied and 7 remain vacant. The judgements made within this report are based upon information supplied by the home, from interviews with staff, people who use the service and their relatives. During the course of inspection the assessment information and care plans were inspected for 6 people who use the service. Medication administration was checked. Staff records were seen to check staff rotas, recruitment procedures and training. Various documents were seen in order to check compliance with health and safety legislation. A tour of premises was also undertaken and observations of care practices and interaction between staff and people who use the service was completed. Discussions took place with 3 members of staff on duty and several people using the service and two visiting relatives were spoken to throughout the day of inspection. The Responsible Individual – Mr Hareedran Balasubramaniam was present part of the inspection. Ms Sharon Nugent – Senior Carer was also present throughout this visit. All the information received from the care home was considered and discussed with the Responsible Individual and the Senior Carer. The Inspector wishes to thank the Responsible Individual, Ms Nugent, the staff, people using the service and their relatives for their assistance and cooperation on the day of inspection. What the service does well: The home makes every effort to provide people with a good care to meet their assessed needs following a care plan. The home has a good key worker system and staff supervision system in place. The home communicates well with the families, friends and representatives of people who use the service and welcomes visitors. People who use the service say they are happy and content with living in a homely and caring place. The home provides a relaxed, comfortable and friendly atmosphere where people are treated with respect and in a dignified way. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 6 People who use the service are often vulnerable both physically and emotionally and the Registered Provider/Registered Manager ensures that staff recruited have the ability to carryout personal care services for people sensitively and tactfully. The recruitment of good caring staff is critical to the running of care homes and the Registered Provider and the Registered Manager at Avenue House undertakes this carefully. The home has a good staff training and development programme in place. A majority of staff have received mandatory training in safe working practice topics, Dementia care, safe handling of medication and NVQ Level 2. Thus training will ensure that the staff have improved their knowledge and skills to meet the changing care needs of people who use the service. The home provides good standard of accommodation and facilities for people using the service. What has improved since the last inspection? Two requirements out of three and one recommendation out of two have been implemented by the home. The home now has a Registered Manager in post and she is embarking on gaining the required qualifications. Conversations with staff, people who use the service and their relatives, indicated that the Registered Manager is service user focused, leads and supports an enhanced staff team providing them with improved training and supervision. This style and approach to management aims to pursue future improvements in all aspects of service. One person who live at the home stated that “This place is a lot more peaceful and better organised”. The home has made good improvements in their recordkeeping and care planning. Care Plans seen for people who use the service were informative and gave some indication of how care is to be delivered for each of them. Medication practices have improved and more staff have received training in safe handling of medication. All staff with the exception of two have completed their training in Dementia care and that will enable them to expand their knowledge and skills and enhance the care they give to people using the service. It was noticeable that there have been many improvements made to the environment of the home along with the recent application for variation of the conditions of registration for initially six places for people with Dementia care needs. A rolling programme of redecoration has been implemented, and communal areas have been redecorated. The garden and patio areas at the rear of the premises have been improved and made accessible and secure. Appropriate locks have been fitted to all the bedrooms. A suitable and safe Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 7 sheltered space has been provided for people using the service who wish to smoke. 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 DS0000064388.V352433.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Everyone receives a full needs assessment prior to admission to the home to make sure that their needs can be met. EVIDENCE: Avenue House care home provides detailed and clear information, in the form of a Service Users’ Guide, to people who will be using the service and their families to enable them to make decisions about whether or not to live at the home. Copies of this Guide were seen in people’s bedrooms. Admissions are not made to the care home until a full assessment has been undertaken. The home is then able to confirm that they can meet the needs of the individual through the service they deliver as detailed in the Statement of Purpose. For people who are self-funding and without a care management assessment, they always receive assessment by the Registered Manager. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 10 Six files/care plans of people who use the service were inspected, which contained pre-assessments of their needs, both from assessments by the home’s senior staff and other relevant professionals. Observations and discussions with people using the service, their visiting relatives, the Registered Provider, Senior Carer and staff on duty indicated that the home continues to meet the needs of older people and those with Dementia care needs in a satisfactory and sensitive manner. It was noted from the staff training records that 14 members of staff have completed their training in Dementia care and 2 remaining members of staff have also been enrolled to undertake this mode of training. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People who use the service have individual plans of care, which ensures that their personal, healthcare and social needs can be met. Medication is administered and stored in a manner that safeguards everyone using the service. People using the service are treated with respect and dignity and their right to privacy is understood and upheld. EVIDENCE: People who use the service undergo an assessment of their needs prior to admission to the care home. A Care Plan is produced, which is based on the assessment of needs. The home operates a good key worker system, which helps to ensure that the recommendations arising from the care plan reviews are implemented. Six Care Plans of people using the service were case tracked and examined in detail. There was evidence to show that the short-term goals and long-term goals, aims and objectives were clearly identified and appropriate interventions required to meet the individual needs of people who use the service were also identified. The quality and detail of daily care Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 12 recordings have improved since the last inspection. However, the Registered Manager should continue to make further improvements and staff should be supported and closely supervised in this endeavour. Discussions with people who use the service showed that the home has a good ethos of involving them in all aspects of their life. The care plans that were read were clearly written and included an element of risk assessment. Information from the initial assessments had been written into plans of care. The care plans are reviewed on a monthly basis by staff, but they need actual dates recorded not just the month of September or October. Care Plans demonstrated that the staff actively promoted the rights of people who use the service of access to the health services both within the home and the community. Appointments are planned or arrangements are made for professionals to visit frail people using the service. However, it was seen from the care plans that the people using the service are not being weighed on regular basis to monitor for the gain or loss of their weight. Whenever possible continuity of care for the service users’ declining state of health is assured. District Nurses are called upon to assist with clinical help, equipment and advice where necessary. The Registered Manager promotes the key worker system so that relationships between staff and individuals are enhanced. Visitors are able to meet people using the service in their bedrooms and in the lounges on the ground floor. It was observed that people who use the service were being treated with respect and staff were working both professionally and sensitively in meeting individual needs. Inspector spoke at length with several people who use the service and all of them commented positively about their care and felt that they have everything that they need. Five people who use the service stated that “The carers are very good and kind and they look after us very well”. Two other people using the service said ”The carers are always there to help”. Generally people who use the service appeared to be content and comfortable. They were complimentary regarding the quality of their lives and care they were receiving at Avenue House – care home. There are appropriate policies and procedures in place for the administration of medication. It was noted that the care plans contained a list if current medication. The Senior Carer stated that reviews are carried out on regular basis of all care plans to ensure that medication details are up to date. Appropriate records are kept of all medicines received, administered and leaving the home. A random sample of medication cassettes and administration sheets were seen at the inspection and there were no discrepancies. The medicines mobile trolley was clean and in good order, and Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 13 securely stored after use in the small lounge. Daily checks are taken of the temperature of the medicines’ refrigerator. There are no controlled drugs stored at the home at present. The Registered Manager is, however, aware that suitable storage, administration and recording arrangements must be in place if any service users are prescribed controlled drugs. Medication rounds were observed during the inspection. Staff were seen to administer and record when medicines had been given. The Senior Carer stated that 6 members of staff who are responsible for safe handling of medication have received training in safe handling of medication. The staff training records showed that there are 7 members of staff who are currently undertaking training in safe handling of medication. It was observed on the day of inspection that no personal care interventions were undertaken in communal areas. In addition, consultations with health and social care professionals are carried out within the service users’ bedrooms. Visitors are able to meet in the bedrooms of people using the service and in the lounges. The staff work hard to try and maintain the dignity of people who use the service, which can be difficult at times due to the types of illness and conditions they have. People who use the service are able to make and receive telephone calls in private in designated area in the home. Relatives have commented that they are pleased with the care their relatives received at Avenue House. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 25. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. People using the service are unable to exercise choice with their activities, because of lack of variety of social and recreational opportunities inside and outside of the home. Relatives and friends are encouraged and assisted to maintain contacts with people who use the service. People who use the service are helped to exercise and control over their lives as far as possible and safe to do so. The dietary needs of people who use the service are well catered for with a balanced diet and varied selection of foods, of ample quantities to meet the tastes and individual requirements. EVIDENCE: The home provides an activities programme, which is limited in meeting everyone’s choices, preferences and capacities in relation to – social, leisure and cultural interests. People using the service, who were able to give opinion, were complimentary about the activities, but added that there is lack of choice and variety. The records of activities participated by some of the people using the service are kept. However, these records of activities are not incorporated into individual care plans of people who use the service. It was also seen from Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 15 records that some of the people using the service have not taken part in any activity at all. Those people who are able to have meaningful conversation told the Inspector that “some of the activities that are offered are not for adults, because we are not children”. However, it was observed on the day of inspection that several people using the service were sitting in the lounges chatting to staff and to each other in a well integrated way. There was detailed discussion held with the Registered Provider and the Senior Carer about the suitability of the current social and leisure activities programme for all the people using the service and thus the needs to provide appropriate activities according to individual people’s needs, choice, preference and capacity. The Registered Provider stated that staff will be asked to be more pro-active in encouraging all people who use the service to be involved in the activities in door and outdoor of the home. The care plans will also contain detailed information about service users’ likes and dislikes, interests, choices, preferences and capacities. The Annual Quality Assurance Assessment (AQAA) received from the care home on 7th November 2007 states that “our plans for improvement in the next 12 months are to ensure staff are allocated Quality Time to ensure activities are readily available for people using the service and the home is to be adequately staffed to ensure this”. It also states that information about activities is to be circulated to all service users in the formats suitable to their capacities. The home will also look into bringing people from outside of the home to assist with activities; and to consider appointing an activities coordinator to arrange outings and also parties throughout the year. The garden at the rear of the building now has been made safe and accessible to use and there is also a new small patio area created with slabs near the back door of the lounge/dining room. There is good quality of garden furniture provided for people who use the service. Several people using the service spoken to stated that they were in regular contact with their family members and friends, and spoke about their visitors’ involvement and interest in their care matters. The visitors’ book kept in the home showed a considerable activity. One service user is living very independently and is able to go to local shops, park and even to the city centre. The Registered Provider stated that the people using the service were positively encouraged and helped to exercise their choices and control over their lives and daily living, subject to risk assessment in terms of safety, security and capacity to make certain decisions. The Registered Provider stated that a close liaison is maintained with the relatives and representatives, where the people using the service are not able to make certain decisions. The relatives of people using the service and their representatives are informed of the availability of the local Advocacy Service. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 16 Several people who use the service told the Inspector “The home is very good and it’s quiet here”. “The food was very nice and well cooked and tasty”. The consensus of people who use the service was the range, quality and choice of food provided was very good and the home catered for those people using the service, who have individual preferences and medical needs. The Registered Provider stated that the menu is changed on a regular basis in consultation with people who use the service. Three full meals are offered each day. In addition, supper is offered during the evenings and snacks and drinks are available throughout the day. All people who use the service asked said that the food was of good quality. The kitchen is well equipped and kept clean and tidy. The kitchen staff are trained in food safety and hygiene matters. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 17 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): 16 and 18. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. People using the service were confident that they could raise any complaints they had with the staff or manager but their protection would be enhanced by updating of policies and staff training about prevention of abuse. EVIDENCE: The home has a good Complaints Procedure in place, which is referred to in the home’s Service Users’ Guide and in the Statement of purpose. There is a system of recording concerns and complaints. The home’s records showed that the Commission for Social Care Inspection (CSCI) has not received any complaints since the last inspection. Three people who use the service when asked were certain of how to formally make complaint but they said they would happily talk to one of the staff in charge or the Manager. The home’s Adult Protection Procedure is not in line with the local Social Services Department’s Multi-Agencies Procedure. This must be changed as a matter of priority as the current procedure conveys the wrong information in some areas. It is understood that the Registered Manager is shortly to obtain a copy of the Social Services Procedure and will update the home’s procedure accordingly. The home has a copy of the Department of Health’s Document, “No Secrets”. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 18 The home has not had to report any vulnerable adult protection issues. The home has good policies and procedures in place regarding restraint, dealing with aggressive behaviours, and prevention of abuse, which includes a whistle-blowing policy. Any monies kept in safekeeping on behalf of people using the service are securely stored, with records maintained. The staff training records showed that none of the staff as yet received formal training in Adult Protection/Safe guarding issues. The Registered Provider is aware of this deficiency. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 19 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): 19 and 26Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Avenue House provides a comfortable, homely and secure place to live. EVIDENCE: The home offers a comfortable and well-maintained environment to people who use the service. The home has ample communal space – two lounges, and a dining room. The home has a rolling programme of redecoration to maintain good standards. The garden and patio areas were well - maintained. The home has provided suitable aids and adaptations in the home to meet the general and specific needs of people who use the service. Bedrooms entered were personalised according to individual wishes and tastes. Communal areas were clean and comfortable. People who use the service have access to a large garden and patio areas, which have been recently improved. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 20 During the day of inspection, the home was found to be clean, and free from any unpleasant odour. The home has good policies and procedures in place regarding infection control. The staff training records showed that 8 members of staff have received training in infection control and 8 members of staff are currently undertaking this mode of training. In addition, all members of staff have received induction training and they are made aware of the dangers of cross-infection. The Registered Provider stated that an application for a major variation to the conditions of registration to include Dementia care, initially for 6 older people, is currently being processed by the CSCI. The Regional Registration Team has undertaken a site visit to the home and they have made a series of recommendations and requirements concerning the present environment of the home, which is not designed in dementia friendly way i.e. small rooms, busy wall paper and painting pattern carpets. The designated areas to be used for or by people with dementia care needs to include clear signage, sensory boards, reminiscence boards, rummage bags and easy useable equipment. The Registered Provider stated that all the above issues are currently being addressed appropriately and shortly to ensure the home’s environment is suitable and friendly for people with dementia care needs. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The number of staff on duty has improved and there are sufficient numbers of staff to meet the needs of people using the service. The recruitment procedures have improved and now better protect people using the service from the risks of employing unsuitable staff. The home continues to support staff to complete training. EVIDENCE: Information provided by the home and available staff rotas for the weeks commencing 3rd November to 30th November 2007 indicated that the home is adequately staffed. There is one senior carer and two carers on duty throughout the day and two carers at night wakeful duty. The cook cover is provided for seven days a week, but domestic cover is only provided for five days a week. The handyperson is on duty three days a week. The evening tea cook cover and weekend domestic duty cover, which is currently being provided by care staff in addition to their caring duties was discussed with the Registered Provider and he undertook to address this staffing matter when the number of people using the service increased. Staff training records showed that nine members of care staff have completed their NVQ Level 2 qualification, two carers are currently undertaking this mode of training; two carers are also enrolled to undergo this training shortly and Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 22 those who as yet have not enrolled to undertake this mode of training will be do so shortly. The home does not employ Agency staff. The staff team is a well - balanced group in terms of age, experience and ethnicity. Six staff files were examined in detailed in order to check compliance with the recruitment requirements. All six files contained copies of two written references and a full employment history. There was evidence on staff files that all six had been subject to satisfactory Criminal Records Bureau (CRB) and POVA checks prior to being appointed. All staff were given copies of the General Social Care Council’s Code of Conduct and they sign to verify that they have received it. There was evidence on files that staff have received the statements of their terms and conditions of employment. There is a staff training and development programme in place. In addition to the mandatory training (see NMS OP38), all staff with the exception of two have also taken part in Dementia care training. The Registered Provider stated that those members of staff who as yet have not received training in safe working practice topics will do so shortly. The Registered Manager has commenced the induction training for new staff and formal supervision meetings. The Registered provider also needs to consider providing training in Mental Capacity Act 2005, Diversity and Equality and managing challenging behaviours. Staff confirmed that training is provided and there are many equal opportunities to improve themselves for the benefit of the care of people who use the service. People who use the service commented that they feel safe with the staff caring for them and they felt that the home employs people that are capable of carrying out their care duties. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35, 36 and 38. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that the home is run in their interests. Financial interests of people using the service are safeguarded. The home promotes the health, safety and welfare of people using the service. EVIDENCE: The present Registered Manager Ms Michelle Simmons was appointed as an Acting Care Manager in October 2006 and she was registered with CSCI on 21st March 2007. Ms Simmons is currently undertaking her Registered Managers’ Award, and she is hoping to receive further training in Dementia care, either Diploma or NVQ Level 4. She appears to be managing the home well. There are clear lines of accountability within the home and the Registered Manger is well supported by the Registered Provider. The home has a formal Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 24 staff supervision system in place, and Ms Simmons have already begun to implement supervision of staff and meetings with both staff and people who use the service. Observations made and discussions with people who use the service and their relatives and staff have indicated that the Registered Manager is very approachable and she operates an open door policy. People using the service, who could express themselves stated that they are happy to approach the Manager and staff with any problems they might have and were confident that they would respond to them appropriately. It was noted that the home has a Quality Assurance monitoring system in place. Quality assurance takes place throughout the service in both a formal and informal manner. Meetings, surveys and day to day contacts all provide records to show that satisfaction is at the heart of the service for people using the service. The Registered Provider and the Senior Carer confirmed that the Registered Manager has distributed the quality assurance questionnaires to people using the service and their relatives/friends. The Registered Provider stated that the Registered Manager will complete the report on the outcome of the feedback by the end of December 2007, and the report will be made available in the home and a copy to the CSCI. The Registered Manager also needs to seek views/comments and feedback from other stakeholders or visitors to the home and provide a feedback report in the home and a copy to the CSCI. Financial records and administrative procedures relating to the handling of the monies of people who use the service were looked at and were found to be well ordered and maintained. The home actively encourages people using the service, where able, to manage their own money. The home keeps records to show that health and safety of people who use the service is promoted and protected. However, it was noted that the hot water supply in several of the bedrooms on both floors was inconsistent in terms of maximum temperature level being within the range of 36 Degrees C to 44 Degrees C. The Registered Provider stated that this matter will be addressed immediately. The staff training records showed that majority of staff have received their mandatory training in safe working practice topics, for example, moving and handling, health and safety, fire safety, infection control/COSHH, food hygiene, and first aid. The Registered Provider stated that all those members of staff who as yet have not received mandatory training in safe working practice topics would do so shortly. They will also receive training in Adult Protection, NVQ Level 2 and safe handling of medication. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 25 People who use the service spoken with were very complimentary about the Registered Manager, the owner, and the staff in the home. They knew who they were by names and looked at ease in their presence. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 26 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 N/A N/A 3 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 N/A 18 2 3 N/A N/A N/A N/A N/A N/A 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 N/A 2 N/A 3 3 N/A 2 Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 27 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 OP18 Regulation 13 (6) Requirement All staff must receive Adult Protection training to ensure that people who use the service are not at risk of harm or abuse. The home’s adult protection procedures must be reviewed and updated so that they are in line with the local authority procedure and the Department of Health Guidance, ‘No Secrets’ in order to protect people who use the service. Timescale for action 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The detail and quality of daily care recording should be further improved, and the care plans reviews should also contain actual review dates not just the calendar month. Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 28 2. OP8 All people who use the service should weighed on a regular basis in order to monitor their weight gain and loss and appropriate records should also be maintained in their care plans. The home’s Complaints Procedure should be reviewed and updated and amended copies given to people who use the service. The results of quality assurance surveys should be published and made available to current and prospective service users, their relatives/representatives and other interested parties, including the CSCI. People who use the service should be provided with a wider range of social and leisure activities both indoor and outdoor of the home. The activities should reflect the service users’ choice, preference and capacities. Individual needs in this respect should be recorded in people’s care plans. The Registered Provider must ensure that the ancillary staffing levels are reviewed and increased sufficiently in order to ensure that the care needs of people using the service are appropriately met. 3. OP16 4 OP33 5 OP12 6 OP27 Avenue House DS0000064388.V352433.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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. 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