Care Home: Avenue House Nursing and Residential Home

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What the care home does well People who use the service and their relatives are very positive about the care provided and speak highly of the staff team. Staff know what the needs of people are and care plans are in place to guide them in the care to be provided. People tell us that they get the care that they need and records show that advice and treatment is sought from health professionals where people need this. Avenue House is well managed and people’s concerns are taken seriously and acted on. What has improved since the last inspection? At our last inspection we identified several areas that could be improved on. We said that efforts needed to be made to maintain a consistent management and staff team, to help with continuing the improvements, and providing consistency of care. There is now a manager who has been in post since July 2008 who has worked with staff to make improvements. There has been a reduction in agency staff used, with more permanent staff being recruited. This has helped with consistency of care as staff are familiar with people who use the service and their needs. We made requirements about some aspects of the management of medication at the last inspection. Improvements have been made and liaison has taken place with the General Practitioner to ensure that medication administered through a Percutaneous endoscopic gastrostomy (PEG) feeding tube is safe. Improvements have also been put in place in respect of record keeping, though some additional advice has been given. Additional staff training has taken place and more training is planned for recently recruited staff. What the care home could do better: The main area for improvement is the environment. It was described to us as “tatty and worn in places” which from our observations is a fairly accurateAvenue House Nursing and Residential HomeDS0000067495.V378291.R01.S.doc Version 5.2 description. There was evidence of work being carried out on redecoration and refurbishment, though from our observations the pace of improvement needs to be accelerated to maintain people’s confidence in the service. Key inspection report CARE HOMES FOR OLDER PEOPLE Avenue House Nursing and Residential Home 173 - 175 Avenue Road Rushden Northants NN10 0SN Lead Inspector Kathy Jones Key Unannounced Inspection 30th October 2009 11:10 DS0000067495.V378291.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avenue House Nursing and Residential Home Address 173 - 175 Avenue Road Rushden Northants NN10 0SN 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) 01933 358455 01933 317671 pam.morris@jasminehealthcare.co.uk Jasmine Healthcare Limited Eileen Brown Care Home 46 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (46) of places Avenue House Nursing and Residential Home DS0000067495.V378291.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 with Nursing - Code (N) To service users of the following gender category: Either Whose primary care needs on admission to the home are within the following categories: Older Persons - Code OP Dementia - Code DE. The maximum number of service users who can be accommodated within the category Dementia (DE) is: 10. The maximum number of service users who can be accommodated is: 46. 31st October 2008 2. 3. Date of last inspection Brief Description of the Service: Avenue House is a 43 bedded home located on the outskirts of Rushden, owned by Jasmine Healthcare Limited. The home provides for elderly people requiring personal care or nursing care. There are up to 10 places for people with dementia and 8 places for people who are terminally ill. The home was formerly two domestic dwellings, which have been connected and extended. Residents’ bedrooms are located on the ground and first floors with a small passenger lift providing access to the first floor. Some of the bedrooms on the ground floor have doors leading out onto the garden. Five of the bedrooms are shared and the remainder are single rooms. Communal areas consist of four lounges, a dining room split in two areas plus one small dining room with one table. The Service User Guide dated August 2008 contains clear information about charges. The guide states fees charged range from £350 per week to £700 per week. This range of charges includes costs for personal care towards the lower end of the scale and nursing care towards the higher end of the scale. Service Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.2 Page 5 users who receive nursing care will receive a payment of at least £101 per week, which will be collected directly by the care home from the local Primary Care Trust. The fees calculated will also be dependent on the care needs / dependency of the service user as well as the room selected. The service user guide provides details of what is and what is not included in the fee and gives examples of additional costs. Fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, transport, escort by staff for appointments and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. These are just some examples it is important to read the guide in full. A copy of the key inspection report for May 2008 published by The Commission for Social care Inspection was available on the hall table. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for people who use the service. Inspection of the standards was achieved through review of existing evidence and information received since the last inspection and an unannounced inspection visit to the home. The pre-inspection planning was carried out over the period of half a day and involved drawing all of the information together by reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. The last inspection took place in October 2008. An application to vary the conditions of registration was being assessed by the Care Quality Commission registration team at the time of this inspection. The application was to increase the number of beds registered for people with dementia. Some advice given as part of this assessment of the application has been included in this report. This unannounced inspection visit covered the morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’, which involves selecting samples of people’s records and tracking their care and experiences. Observations of the homes routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. Not all of the people we observed during the inspection were able to express their views on the care easily, either due to being very poorly or due to having a dementia type illness. We received completed surveys from four people who use the service, two relatives and two staff. This information has been incorporated into our inspection findings. The management of people’s medication was checked through reviewing prescribed medication for a sample of people and looking at the systems in place to manage this. A sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.2 Page 7 Communal areas and a sample of bedrooms were viewed and observations were made of people’s general well being, daily routines and interactions between staff and people who use the service. Verbal feedback was given to the registered manager and some additional information and clarification has been received following the inspection. What the service does well: People who use the service and their relatives are very positive about the care provided and speak highly of the staff team. Staff know what the needs of people are and care plans are in place to guide them in the care to be provided. People tell us that they get the care that they need and records show that advice and treatment is sought from health professionals where people need this. Avenue House is well managed and people’s concerns are taken seriously and acted on. What has improved since the last inspection? What they could do better: The main area for improvement is the environment. It was described to us as “tatty and worn in places” which from our observations is a fairly accurate Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.2 Page 8 description. There was evidence of work being carried out on redecoration and refurbishment, though from our observations the pace of improvement needs to be accelerated to maintain people’s confidence in the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 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 Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3, Standard 6 was not assessed as intermediate care is not provided. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission and assessment process helps to ensure that people’s needs can be met. EVIDENCE: People told us that they had received enough information to help them to make a decision about whether Avenue House was the right place for them. Written information is available in the form of a statement of purpose and service user guide. These documents were revised shortly before the last inspection in October 2008. At that inspection we found that these documents provide prospective and current people who use the service with very good information about Avenue House and the services available. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 11 Some advice on further improvements, to make the information more accessible to people, was given during a recent site visit to consider an application to vary the conditions of registration. This advice included using a larger print for the documents. We looked at the care records for someone who had recently been admitted to Avenue House. We found that an assessment had been carried out prior to admission which had gathered relevant information about the person’s health and care needs and the need for any specialist equipment. Consideration had been given to whether the person had the capacity to consent and a check list was in place to determine if there was any deprivation of liberty issues. Information about the persons life and social interests had been gathered which helped to provide an understanding of the person. The information gathered as part of the assessment was sufficient to help form a judgement about whether the persons needs could be met at Avenue House, though advice was given to consider diversity issues more fully when considering people’s needs. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the care that they need with support from external healthcare professionals. EVIDENCE: Positive comments were received from people using the service and their relatives about the care they get at Avenue House. The majority who commented said they always get the care they need and others said they usually did. One of the comments we received was from someone who had moved from another home and they commented “I am at long last experiencing what proper care is, I now feel that I am understood and the staff really care”. A relative says “very pleased with how – is looked after”. At our inspection in October 2008, Avenue House was very reliant on agency staff and people told us about some of the difficulties they had with agency Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 13 staff not understanding their needs. The staff team is now more stable and there is not the reliance on agency staff. We observed that staff were clearer about their responsibilities and the team were better organised particularly on the morning shift, leading to more consistent care. Following observations and discussion with staff about who was responsible for monitoring a particular person, we discussed with the manager the need to consider allocating specific staff responsibilities for the afternoon shift which she confirmed was being considered. We looked at a sample of care plans, which provided clear information about the care that staff need to provide to meet people’s needs. A new care planning format has been developed and is being introduced. The format is more person centred, prompting staff to ensure that the plan is based on the needs of the individual. One of the benefits of the system is that it has been developed within the organisation and can be adapted based on its effectiveness in practice in supporting people’s needs. Records show that advice and treatment is sought from relevant professionals regarding people’s health care. Examples included, General Practitioner, Optician, Dietician, District Nurse and Tissue Viability Nurse. People also told us that they get the medical help that they need. We looked at the way people’s prescribed medication was being managed and a sample check told us that people’s prescribed medication was available and securely stored. Records were in place to confirm medication had been administered as prescribed. Two requirements were made at the last inspection about the management of medication. Following the last inspection written confirmation had been obtained to confirm a particular medication could be safely crushed and administered via a Percutaneous endoscopic gastrostomy (PEG) feeding tube. Other medications were supplied in liquid form. The second requirement related to record keeping and the need to have a clear audit trail of medication. We found that a system was in place to record medication received, administered and disposed of as part of an audit trail. The system was complicated and it was difficult to carry out an accurate stock check. Liquid medication was in some instances recorded as the number of bottles rather than the quantity, again making it difficult to check accuracy. There was also some ambiguity with the use of codes on the medication administration records with different staff interpreting them differently. The registered manager told us that efforts had been made to improve the management of medication since our last inspection. This has involved a change to the supplying pharmacist who is able to provide pre-printed medication administration records, which it was felt would enable them to keep Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 14 a clearer record of the management of medication. The change was due to take place the week after our inspection. Staff were heard to speak to and treat people with respect. Comments received from people who use the service and discussion with staff confirmed that staff are aware of the importance of people being treated as individuals. All rooms apart from one were being used for single occupancy at the time of inspection. A privacy curtain was available in the shared room to protect the dignity of the two people sharing the room. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a relaxed atmosphere, with flexible visiting arrangements and a choice of meals. EVIDENCE: There was a calm and relaxed atmosphere and staff were observed to take opportunities to sit and talk to people or assist with a puzzle where time allowed. There is a regular member of staff who organises activities, though they were not working on the day of inspection. A list of activities is displayed in the dining room and these included crafts, card games, dominos, and chair games. Fireworks were planned for 5th November. While people who gave us feedback were satisfied with their daily lives, the improvements in the new care plans will help in gathering more information about individual preferences and help ensure that their needs are fully met. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 16 Visiting arrangements are flexible and relatives told us that the service helps them to keep in touch and keeps them up to date with important issues. We noted that relatives were becoming more involved in agreeing care plans and were being asked to sign them. Advice was given to ensure that where people have been assessed as having the capacity to make decisions, that they rather than the relative had agreed the care plan unless they had requested otherwise. People told us that they like the meals most of the time and if there is something they don’t like they are offered other options. One person said “I am allowed here to do and eat what I want”. A relative commented “food is plentiful and good, choice is not only offered but encouraged and if it is not on the menu every effort is made to accommodate”. The lunch time meal on the day of inspection looked appetising and was well presented. We observed staff to assist people who needed it with their meals. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously and staff are aware of their responsibilities, which helps to safeguard people. EVIDENCE: The Care Quality Commission and its predecessor organisation The Commission for Social Care Inspection, have received no new complaints about the service since the last inspection. Records of complaints made directly to Avenue House, show that the number of complaints has reduced since the last inspection. The registered manager takes complaints seriously, acknowledging and dealing with any shortfalls. Feedback from people who use the service is that they have someone that they can speak to informally if they are not happy and most know how to make a complaint. Staff training records show that the majority of staff have received training in safeguarding vulnerable adults. Staff spoken with, were clear about their responsibilities for reporting any concerns or poor practice and helping to safeguard the people who use the service. No concerns were raised about how Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 18 people are spoken to or treated and one person commented in a survey “My opinion counts and I feel safe”. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rooms are comfortable though some areas are in need of re-decoration and refurbishment. EVIDENCE: We looked at lounges and dining rooms and a sample of people’s bedrooms during the inspection. Rooms were comfortable and bedrooms were personalised with people’s own pictures and ornaments. We had some feedback from people about the environment which included “Décor is tatty and worn in places but we believe this is being sorted out slowly”. We were able to see that there is a programme of redecoration and refurbishment but as the person commented, this is happening at a pace which Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 20 allows some areas to become “tatty and worn in places”. For example on entering the dining room, the poor condition of the carpets is quite noticeable. This area is very well used and a high number of people require assistance with wheelchairs which has an impact on the life of a carpet. A bedroom was being decorated at the time of this inspection and the registered manager advised that rooms were decorated as they were vacated, ready for a new occupant. We did notice that there was a strong unpleasant odour coming from one of the bedrooms, which the registered manager advised that they were having some difficulties in managing and consideration was being given to alternative flooring. The responsible individual has confirmed following the inspection that new flooring which is easier to keep clean and odour free will be fitted. A site visit was undertaken prior to this inspection by an inspector considering an application to vary the conditions of registration to increase the number of dementia places. Advice was given about the need to make some improvements to the environment which would be beneficial whether the number of dementia beds is increased or not. Advice included additional hand rails, improved lighting levels, more signage and replacement of carpets in some areas with good quality non slip flooring. The dining room was one area where replacement flooring was suggested. The responsible individual informed us following the inspection that some new carpets and flooring are on order. One of the washing machines was waiting for repair at the time of the inspection. Staff confirmed that arrangements for repair had been made. Laundry staff were clear about the importance of maintaining good infection control procedures and prioritising washing during this period. Some additional staff have undertaken infection control training since the last inspection. A relative commented “Cleanliness and care of personal items is very good” Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a more stable staff team who are able to provide people with consistent care. EVIDENCE: We received positive comments about the staff team which included “staff are lovely and nothing is too much trouble”, it is happy here and always laughter and kindness towards me”. Information received in surveys was that staff were always or usually available when people needed them. Our observations during the inspection were that people were not waiting lengthy periods for assistance; the staff team were more organised, clear about their responsibilities and responsive to people’s needs. More care staff have been recruited since the last inspection, and at the time of this inspection Avenue House was not reliant on agency staff to cover care shifts. This has improved the consistency of care that people receive. Staff spoken with also felt that the care they provide has improved. Efforts are continuing to recruit additional cleaning staff. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 22 Staff told us that prior to them starting work criminal record bureau checks had been made and references had been taken up which is important in helping to safeguard people who use the service. This was confirmed by checking a sample of staff files. The annual quality assurance self assessment submitted by the registered manager prior to the inspection identifies that eleven out of twenty care staff have achieved a National Vocational Qualification and efforts are being made to increase this number. We spoke with staff who confirmed that they had received training which includes induction training and training in safe working practices. Staff were confident that they were given the training they needed to help them meet people’s needs. The company employ a training manager to oversee staff training and training needs. A matrix of staff training provides an overview of the training that staff have done and need to do. Some gaps were identified where staff have not received mandatory training. Discussion with the registered manager confirmed that the majority of these related to new staff and that plans were in place to ensure that all staff have completed mandatory training. Most staff have done some dementia care training and more is planned. The need to consider some more in depth staff training in dementia care was discussed. This is particularly important if an increase in the number of dementia care places is to be considered. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Avenue House is managed in the best interests of people who use the service. EVIDENCE: There is a manager who has been in post since the end of July 2008. The registered manager is suitably qualified and experienced and has worked hard to improve the quality of care provided. She is a registered nurse and has just completed a management course. Comments from staff, people who use the service and their relatives confirm that the manager is supportive and willing to listen and act where necessary. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 24 The quality assurance system includes regular unannounced visits which are carried out by representatives of the company to check on the quality of care provided. These visits include talking to people who use the service, staff and visitors to obtain their views on their experiences. People’s views are taken seriously and opportunities are also provided for people to comment on the service by giving feedback through meetings and also by completing a survey. Copies of the surveys for completion were available in the hall next to the visitors signing in book. As two of our previous requirements related to medication, we looked at how compliance with these requirements had been monitored. There was quite a lengthy medication audit, though this was not dated and there was no name of the person who had carried this out. It did refer to the requirements we had made, but didn’t appear to consider the action taken to meet the requirement. Some advice has been given about the medication audits and amendments are being made. The findings of this inspection highlight improvements in the overall management of the service, and the care provided. The annual quality assurance self assessment identifies that the reduction in the use of agency staff and increased occupancy has led to an improvement in the financial viability of the service. The responsible individual confirms that this will enable further environmental improvements to be made. Improvements were found in the way records are being organised and managed. Information was easier to locate and the registered manager advised that improved storage arrangements for archived records are being put in place. Small amounts of money are held for some people who use the service to assist them in paying for services such as hairdressing. Records are kept to confirm all transactions helping to safeguard people. Some advice was given to make it easier to cross check receipts with records. There has been an improvement in the number of staff who have received training in safe working practices and further training is planned. This includes training in areas such as fire safety, food hygiene, movement and handling training and infection control. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 25 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 26 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 OP19 Regulation 23 Requirement Plans and timescales for redecoration and refurbishment must ensure that the premises and furnishings are kept in good condition. Timescale for action 30/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP33 Good Practice Recommendations Simpler medication recording systems would make it easier to monitor that medication is safely managed. Quality assurance and audit systems should take account of how regulations and any requirements are being met. Avenue House Nursing and Residential Home DS0000067495.V378291.R01.S.doc Version 5.3 Page 27 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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