Care Home: Avis House

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What the care home does well The home provides a relaxed, comfortable and friendly atmosphere where people are treated with respect and in a dignified way. The home makes every effort to provide people with 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 comments we received via returned Surveys included: • “The service has done very well. Yes – recognise and give staff/management credit where due”. (a relative of a resident) “They do well with all residents. Yes – The staff/management are very nice”. (a service user) “I feel that the home is well run”. (a member of staff) “Avis House provides a safe environment in a homely surrounding for patients with a great level of need of care”. (a health care professional) “The service provides individual programmes tailored to the clients needs. It also provides an appropriate day care programme”. (an Aroma-therapist)•• ••People who use the service are often vulnerable both physically and emotionally and the Registered Provider and the Acting Care Manager ensure that staff recruited have the ability to carry out 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 Acting Care Manager at Avis House undertake 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, including safe handling of medication and National Vocational Qualification (NVQ) Level 2/3. Thus this training will ensure that the staff have improved their knowledge and skills to meet the changing needs of people who use the service. The home provides good standard of accommodation and facilities for people using the service.Avis HouseDS0000017179.V376845.R01.S.docVersion 5.2 What has improved since the last inspection? People commented that: • “Lots of recent improvements to décor, furnishing and fittings etc. I am pleased that it looks much better now”. “The service has done very well. Staff and management are always friendly and pleasant to all”. “The facilities and the care provided by management and staff are good”. “Everything that I have witnessed up to date is carried out with care and regard to the residents’ well being”.•• •The home has an experienced Acting Care Manager in post and he has good skills in managing the care home well. Conversations with staff and people using the service, indicated that the Acting Care 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 lives at the home stated that “This place is a lot better now and it looks brighter”. The home has made some good improvements in their record keeping and care planning. Care Plans seen for people who use the service were informative and gave good indication of how care is to be delivered for each of them. Medication practices have improved and more senior staff have received training in safe handling of medication. The home has organised staff training on infection control. A majority of staff have received training in safe working practice topics and National Vocational Qualification (NVQ) Level 2 and Level 3 and that will enable them to expand their knowledge and skills and enhance the care they give to people using the service. What the care home could do better: The home should continue to improve further the detail and quality of daily care recordings. Activities enjoyed by the people who use the service should be consistently recorded, evaluated and incorporated into their individual care plans. Those members of staff who as yet have not received training in safe working practice topics and/or updates/refresher training, including safe handling of medication, Dementia care, NVQ Level 2, adult protection and safeguardingAvis HouseDS0000017179.V376845.R01.S.doc Version 5.2 issues must do so as a matter of priority. This training would enable staff to improve further their care practices, knowledge and skills. The AQAA submitted prior to this visit by the Acting Care Manager stated that “We will continue monitoring of our services, improve care plans with changing needs. Enhance communication/information services for service users so they have greater voice/expression of issues, needs and wishes”. Key inspection report CARE HOMES FOR OLDER PEOPLE Avis House 12 Old Fallings Lane Fallings Park Wolverhampton West Midlands WV10 8BH Lead Inspector Bhag Jassal Key Unannounced Inspection 10th August 2009 09:30 DS0000017179.V376845.R01.S.do c Version 5.2 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. Avis House DS0000017179.V376845.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 Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avis House Address 12 Old Fallings Lane Fallings Park Wolverhampton West Midlands WV10 8BH 01902 866036 F/P 01902 866036 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) Not known Alphonsus Services Limited Miss Helen Jones Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Learning Disability who may also have Physical Disability and under 65 years on admission The Manager must provide details of any conditions to be made or varied. 12th August 2008 Date of last inspection Brief Description of the Service: Avis House is a home providing accommodation, personal and nursing care to six people with a learning disability who may also have a physical disability. All but one person is over the age of 65. The home is purpose built and is situated in the Low Hill area of Wolverhampton and offers access to local amenities and public transport. The accommodation is based on one floor providing single bedrooms, a domestic style kitchen, a dining room, sensory room and a lounge. Car parking is provided to the front of the building and people have access to a large enclosed garden. Prospective service users and their representatives are able to gain information about this service from the Statement of Purpose and Service Users’ Guide. Inspection reports produced by CQC are available in the home for people to read. These are also available on our website at www.cqc.org.uk Information about the fees are included in the Service Users’ Guide which states that the provider has a block contract with the local authority and is not directly responsible for the fees payable due to a block contract agreement. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use the service experience Good quality outcomes. This report is on a Key Inspection, part of which includes an unannounced visit undertaken on 10th August 2009. The unannounced visit started at 09:30 and lasted 8 hours and 20 minutes. The home had 5 people in residence and there is one vacancy. The judgements made within the report are based upon information supplied by the home, from interviews with the Acting Care Manager, the staff and people who use the service. During the course of inspection the assessment information and care plans were examined in detail for two 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. We looked at the areas of the home used by people living there and observed care practices and interaction between staff and people using the service. Discussions took place with several members of staff and four people who use the service throughout the day of inspection. Acting Care Manager – Mr Howard Young was present throughout the inspection process. On this occasion all twenty two of the key Standards of the National Minimum Standards for Care Homes for Older People were assessed – that is those areas of service delivery that are considered essential to the running of a care home that ensure the best outcomes for people living at Avis House. Regulation 37 Notifications, concerns and complaints against the home and Annual Quality Assurance Assessment (AQAA) completed by the Acting Care Manager and submitted to the Care Quality Commission (CQC) prior to this inspection were considered. The AQAA is a self - assessment and a dataset that is filled in once a year by all Registered Providers. It informs us about how Registered Providers are meeting outcomes for people using their service and is an opportunity for Registered Providers to share with us areas that they believe they are doing well. Information within this document demonstrates that the Acting Care Manager recognises the strengths and weaknesses within the service and is able to plan for improvement. We wish to thank the Acting Care Manager, the staff, people who use the service for their assistance and co - operation on the day of inspection. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 6 What the service does well: The home provides a relaxed, comfortable and friendly atmosphere where people are treated with respect and in a dignified way. The home makes every effort to provide people with 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 comments we received via returned Surveys included: • “The service has done very well. Yes – recognise and give staff/management credit where due”. (a relative of a resident) “They do well with all residents. Yes – The staff/management are very nice”. (a service user) “I feel that the home is well run”. (a member of staff) “Avis House provides a safe environment in a homely surrounding for patients with a great level of need of care”. (a health care professional) “The service provides individual programmes tailored to the clients needs. It also provides an appropriate day care programme”. (an Aroma-therapist) • • • • People who use the service are often vulnerable both physically and emotionally and the Registered Provider and the Acting Care Manager ensure that staff recruited have the ability to carry out 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 Acting Care Manager at Avis House undertake 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, including safe handling of medication and National Vocational Qualification (NVQ) Level 2/3. Thus this training will ensure that the staff have improved their knowledge and skills to meet the changing needs of people who use the service. The home provides good standard of accommodation and facilities for people using the service. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? People commented that: • “Lots of recent improvements to décor, furnishing and fittings etc. I am pleased that it looks much better now”. “The service has done very well. Staff and management are always friendly and pleasant to all”. “The facilities and the care provided by management and staff are good”. “Everything that I have witnessed up to date is carried out with care and regard to the residents’ well being”. • • • The home has an experienced Acting Care Manager in post and he has good skills in managing the care home well. Conversations with staff and people using the service, indicated that the Acting Care 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 lives at the home stated that “This place is a lot better now and it looks brighter”. The home has made some good improvements in their record keeping and care planning. Care Plans seen for people who use the service were informative and gave good indication of how care is to be delivered for each of them. Medication practices have improved and more senior staff have received training in safe handling of medication. The home has organised staff training on infection control. A majority of staff have received training in safe working practice topics and National Vocational Qualification (NVQ) Level 2 and Level 3 and that will enable them to expand their knowledge and skills and enhance the care they give to people using the service. What they could do better: The home should continue to improve further the detail and quality of daily care recordings. Activities enjoyed by the people who use the service should be consistently recorded, evaluated and incorporated into their individual care plans. Those members of staff who as yet have not received training in safe working practice topics and/or updates/refresher training, including safe handling of medication, Dementia care, NVQ Level 2, adult protection and safeguarding Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 8 issues must do so as a matter of priority. This training would enable staff to improve further their care practices, knowledge and skills. The AQAA submitted prior to this visit by the Acting Care Manager stated that “We will continue monitoring of our services, improve care plans with changing needs. Enhance communication/information services for service users so they have greater voice/expression of issues, needs and wishes”. 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. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 looking for a care home can be confident that Avis House can support them. This is because information about the service is made available to help them make an informed choice about whether the home is able to meet their individual needs. A complete assessment of a prospective service users needs is undertaken with them and others close to them, and people are given the opportunity to visit the home and see it to ensure the service is right for them. EVIDENCE: Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 11 Information about the service is readily available in the Statement of Purpose and Service Users’ Guide. Both documents have been recently updated and provide people with information to help them understand the services that Avis House provides. There have been no new admissions to the service since our last inspection. However, there is now one vacancy. The home has a detailed admissions procedure which indicates that a needs assessment would be obtained for any prospective service user and trial visits offered to ensure the home is suitable for meeting the person’s individual needs. Two files/care plans of people who use the service were looked at, which contained pre - admission 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, the Acting Care Manager, and staff on duty indicated that the home continues to meet the needs of older people in a satisfactory and sensitive manner. It was noted from the staff training records that a majority of staff have undertaken their training in NVQ Level 2/3 and safe working practices. The home does not provide a service for those assessed and referred solely for intermediate care, who require help to maximise their independence and return home. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 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): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use 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 who use 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. Two Care Plans of people using the service were inspected Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 13 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 daily care and outcome of staff interventions are appropriately recorded. Discussion 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 senior staff. 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. Whenever possible the continuity of care for the declining state of health of people who use the service is assured. Heath professionals are called upon to assist with clinical help, equipment and advice where necessary. The Acting Care 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 or in the lounge 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. We spoke at length with four people using the service and all of them commented positively about their care and felt they have everything that they need. Two people who use the service stated that “The carers are very good and kind and they look after us very well”. Two other people who use the service said “The carers are always there to help us”. 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 Avis House care home. A completed Survey received states “Avis House provides good quality of care for all service users. We have very good, friendly staff who are always available to deal with anything and who put all service users and their needs first”. Another relative stated “Avis House is a very welcoming home. All the residents are very happy. The staff are very professional and very approachable and extremely helpful”. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 14 There are appropriate policies and procedures in place for the administration of medication. It was noted that the care plans contained a list of current medication. The Acting Care Manager stated that reviews are carried out on a regular basis of all the care plans to ensure that medication details are up to date. Appropriate records are kept of all medicines received, administered and leaving the home. Random sample of medication and administration sheets were seen at the inspection and there were no discrepancies. All the medicines are stored in the medication room kept under lock and key. Daily checks are taken of the temperature of the medicines in the refrigerator and the medication room. There are no controlled drugs used at present by any service user at the care home. However, if there is a need to store such drugs securely and safely in a lockable metal cupboard, which is available in the medication room. Medication rounds were observed during the inspection. Nursing staff were seen to administer and record when medicines had been given. The Acting Care Manager stated that all senior staff responsible for administering medication were appropriately trained in safe handling of medication. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 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): 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 are provided with opportunities to participate in varied activities of their own choice and according to their interests and capabilities and are enabled to keep in contact with family and friends. People who use the service receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Arrangements for social activities, hobbies and interests are documented in the Statement of Purpose. Peoples own preferences were seen on the two files sampled and the four people we spoke to told us about the things they do in the home and the community. During the inspection two people were Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 16 supported to go personal shopping and have a pub lunch in Wednesfield, Wolverhampton. The people remaining in the home enjoyed using the sensory room, reading, and watching television. One person said ‘I like going to tea dances and shopping and reading magazines. We had a lovely garden party here and lots of people came. Records for another person we looked at indicated that they had been to Bilston market, Tettenhall pool, had aromatherapy and sessions in the new sensory room based in the home. Four 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. People who use the service also keep contacts with the local community, for example, church services, pubs, shops and park. Four people who use the service told us that they are happy with the care and social activities offered by the care home. They further added “the home provides a good service and the staff are very caring and they are pleasant”. The home also provides a variety of indoor activities, including sensory/music therapy, board games arts and crafts, card games, writing skills, cooking, festive and birthday parties. The Acting Care Manager stated that the people who use the service were positively encouraged and helped to exercise their choices, and control over their lives and daily living, subject to risk assessments in terms of safety, security and capacity to make certain decisions. The Acting Care Manager also 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 Advocacy Service based at the local Age Concern. However, this information about the Advocacy Service is currently not included in the home’s Statement of Purpose and Service Users’ Guide. The Acting Care Manager stated that this information will be included in the above documents shortly. The Menu seen reflected the choice of food offered on the day of inspection and appeared balanced and nutritional. However, the four weekly menus seen did not offer alternative choice in the daily meals. The Acting Care Manager stated that these menus will be revised shortly in consultation with people using the service, and also will take into account their special or health dietary needs and requirements as well as seasonal changes. The meal served at lunchtime was well presented and staff were observed to make the mealtime a social and enjoyable experience. Individuals requiring assistance with lunch were offered this in a sensitive manner. Four people who use the service told us “The home is very good and its peace and quiet here”. “The food was very nice well cooked and tasty”. The consensus of people using the service was the range, quality and choice of Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 17 food provided was very good and the home catered for those people using the service, who have individual preferences and medical needs. The kitchen is well equipped and kept clean and tidy. The staff are trained in food safety and hygiene matters. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 18 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): 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 living at Avis House have access to a complaints procedure, which is accessible to them and their representatives if they need to make a complaint. Staff have an understanding in adult protection to ensure people who use the service are protected from abuse and have their legal rights protected. EVIDENCE: The home has a complaints procedure in place and this is available in the Statement of Purpose, Service Users’ Guide and displayed in the reception area of the home. The home or CQC have not received any concerns or complaints since the last inspection. Feedback received from surveys completed by people using the service and staff indicated they are familiar with the process. The home has a copy of the local multi-agency safeguarding adult policy and procedure. No referrals under safeguarding adult procedures have been triggered since the last key inspection. Some staff have received training in adult protection and staff spoken with indicated they had an understanding of whistle blowing and safeguarding adult procedures. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 19 People, who use the service, when asked, were certain of how to formally make a complaint but they said they would quite happily talk to one of the staff or the Manager. The home has good policies and procedures in place regarding restraint, dealing with aggressive behaviour and prevention of abuse, which includes whistle - blowing policy. The Acting Care Manager stated that adult protection and safeguarding issues are discussed during induction training and supervision meetings. The Acting Care Manager stated that some staff have received formal training in protection of vulnerable adults and safeguarding and those who as yet have not received this training or updates will do so shortly. He also stated that trainers are being approached to set up this training. Training in Mental Capacity Act 2005, including Deprivation of Liberty (DoLS) is being held shortly. Three people who use the service stated they are satisfied with the service provision, feel safe and well supported by staff that have their protection and safety as a priority. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 20 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): 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 are provided with a homely, clean and comfortable place to live where they feel safe and secure. EVIDENCE: The home offers a comfortable and well - maintained environment to all people who use the service. The home has ample communal space – a lounge and a dining room. The home has a rolling programme of redecoration to maintain good standards. The large garden and patio areas at the rear are well maintained. The home has provided suitable aids and adaptations in the home Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 21 to meet the general and specific needs of all the people using the service. There are adequate numbers of bathrooms and WCs in the home. The home offers a comfortable and well - maintained environment to all people who use the service. It was noted that the bedrooms are “personalised” by all of the people using the service. During the day of inspection, the home was found to be clean, tidy and free from any unpleasant odour. The AQAA completed by the Acting Care Manager states that, new carpets in the lounge and dining room have been provided. A number of bedrooms have been redecorated and provided new flooring. However, during the tour of the premises we noted the following issues:• That the self - closure mechanism fitted on a number of doors in the home in need of adjusting to ensure that the doors fully close properly to their rebate. This is to ensure the fire safety of all people using the service. The hot water temperature in a number of hot water outlets including bathrooms and bedrooms taps were tested and found to be between 47 to 48 Degrees C. Appropriate action should be taken to ensure that the hot water supply is maintained at the recommended level of hot water temperature of close to 43 Degrees C at all times. This is to ensure that people using the service enjoy safe supply of hot water without the risk of scalding. • The Acting Care Manager stated the above issues will be addressed immediately. The home has good policies and procedures in place regarding infection control. The Wolverhampton Primary Care Trust’s Infection Prevention and Control Team conducted an infection prevention and control audit on July 2008 and the overall result of the audit was 95 , which is an excellent score or gold award for the home. It was also noted from the staff training records that a majority of staff have undertaken training in infection control. It was noted that all new members of staff received induction training and they are made aware of the dangers of cross – infection. People we spoke with during the inspection indicated that they enjoy living at the home and that their rooms are comfortable. The home provides a relaxed and homely atmosphere and is accessible to all, including people who use a wheelchair. A number of improvements have been made since our last inspection to include a fully equipped sensory room, the replacement of some furniture in the lounge, dining room and bedrooms and new curtains in communal areas. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 22 It has been identified at the last key inspection that one person would benefit from the bath in one of the bathrooms being replaced with a level access shower facility to attend to her personal care needs more effectively as she has difficulty using the hoist. This has been identified on the maintenance plan and programme of renewal and approved last year, yet remains outstanding therefore should be given priority in the best interests of the person concerned. People are provided with a clean home which is free from any odours. The home does not employ domestic staff therefore it is the responsibility of care and nursing staff to help maintain a clean and safe environment for people living at the home. Products hazardous to health are appropriately stored and data assessments have been obtained for all substances used and made accessible to staff. Laundry facilities were found satisfactory. We have agreed that a sluicing disinfector is not required given the needs of the people currently accommodated however this must be kept under review. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 23 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): 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. Avis House care home is staffed by well - trained and experienced staff to meet the needs of people who use the service. There are robust recruitment procedures in place to protect people who use the service. There is a good training programme in place that ensures staff are competent to do their jobs. New members of receive structured induction training. EVIDENCE: Information provided by the home and available staff rotas for the period of 13th July to 16th August 2009 indicated that the home has sufficient nursing and care staff to meet the needs of the five people using the service at present. There is one nurse and two carers on duty in the morning and one nurse and two carers in the late afternoon shift. Between 9:00 and 16:00, there three day care staff on duty, which includes a senior day care officer and two day care officers. A nurse and a carer are on wakeful night duty and a Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 24 senior member of staff on - call. The Acting Care Manager’s hours are not always supernumerary. Throughout the inspection staff were accessible, good listeners and communicated well with the people using the service. They appeared motivated and committed to their work. Discussions with three people who use the service and surveys we received indicate that positive working relationships have been developed. One service user said “I like the staff, and they are nice and very helpful to me”. Staff spoke positively about the service and of their roles and responsibilities and demonstrated a good understanding of the individual needs of the people in their care. The staff rota was examined and accurately reflected the staff on duty. People living at Avis House are usually supported by a minimum of three staff throughout the day to include a qualified nurse. Surveys received indicate that staffing levels are usually sufficient to meet the individual needs of people living at the home. Holidays, sickness and vacant posts cover is provided by other staff and bank staff. The Acting Care Manager stated that there are three vacant posts, which includes a day care officer (35 hours per week), two residential care officers (15, and 10 hours per week respectively). There is also 49 hours per week shortfall of nurse time. The Acting Care Manager stated that these vacant posts are being filled shortly. The day care officer’s post is awaiting CRB/POVA clearance. The home employs 19 members of staff comprising of qualified nurses, residential care officers, day care officers and bank staff. The staff training records showed that ten members of care staff have completed their National Vocational Qualification (NVQ) Level 2 qualification and several members of staff have also completed their NVQ Level 3 training. The remaining members of staff who as yet have not received this training will also be nominated to undertake this training shortly. The Acting Care Manager stated that there is ongoing training programme to provide update training in all safe working practice topics. The staff team is a well - balanced group in terms of age, experience, gender and ethnicity. Four staff files were examined in detail in order to check compliance with the recruitment requirements. All four files contained copies of two written references, and a full employment history. There was evidence on staff files that all four had been subject to satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks prior to being appointed. 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) staff also will benefit from training in Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 25 adult protection and safeguarding issues, Mental Capacity Act 2005, including Deprivation of Liberty Safeguards (DOLS), Dementia care, equality and diversity. Staff confirmed that training is provided and there are many opportunities to improve themselves for the benefit of the care of people using the service. All new staff have received their 12 – weeks induction training to the home, including Induction Workbook and 3100 Induction Work Packs, which meets with the Skills for Care standards and specifications. People who use the service commented that they feel safe with staff caring for them and they felt that the home employs people that are capable of carrying out their care duties. Surveys completed and returned by staff states “I feel that the home is run very well”. Another member of staff states” The home provides an individual/needs related package of support to people that represents choice and wishes”. A health care professional states in a completed survey that “They (staff) are always welcoming even on ad-hoc visits. Clients appear happy and well cared for. Advice is sought promptly. It is always a pleasure to visit”. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 26 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): 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 living at the home benefit from a service that is generally managed in their best interests. The premises are maintained in a manner, which ensures the safety of people using the service and the staff. EVIDENCE: Avis House is presently managed by the Acting Care Manager - Mr Howard Young who is a qualified nurse in learning disability, and holds a RNMH (RNLD) Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 27 qualification and he has attended additional training courses appropriate to his role. He is to commence his RMA course in September 2009. Mr Young was appointed in early November 2008 and he has submitted an application to register as a Registered Manager for the home with the Care Quality Commission. The people who use the service and feedback from staff evidenced that the Acting Care Manager is open, approachable and easy to talk to. Discussions indicate that the Acting Care Manager appears committed to improving the service in the best interests of the people living and working at the home. Staff confirmed they are in receipt of supervision with a line manager. One person told us “Support and supervision is regularly offered. During these sessions I also reflect on my practice and share with my manager any concerns. Discussions are usually centred on client care, relationships with other members of the team and whether there are any identified needs for training”. Equality and diversity for service users were seen to be promoted throughout the home within the assessments, care plans, menus, and activities. Equality for staff is promoted through the opportunities for training at all levels. It was noted that the home has a Quality Assurance monitoring system in place. When we spoke with the Acting Care Manager he informed us that satisfaction surveys are due to be distributed shortly and that an external quality audit is to be undertaken very shortly which will help inform future planning and outcomes for people living at the home. The Acting Care Manager also confirmed that he is to distribute the questionnaires to the staff shortly. Mr Young stated that the overall report will be completed on the outcome of the feedback by the end of September 2009 and the report will be made available in the home and a copy to the CQC. However, the home also needs to obtain feedback from other stakeholders, for example, health and social care professionals and visitors to the home and analyse their responses as well. Reports of monthly visits to the home undertaken by a senior manager are readily available, detailed and outline actions required for improvement and assist with monitoring how the home is managed. The home has a policy in place for the management of service users’ finances and arrangements was discussed with the Acting Care Manager and staff on duty that considered procedures to be robust. Two signatures are now obtained for all financial transactions. Records of monies held on behalf of people are maintained and are regularly audited as part of monthly visits undertaken by the Registered Provider. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 28 The home has good health and safety policy and procedures in place, and the staff are aware of their responsibilities regarding these issues and a number of staff have received training in these issues. All safety systems and equipment are regularly checked and well maintained and records of all tests/checks are kept up to date. Service certificates were readily available in addition to risk assessments for safe working practices. The tests on hoists in the bathrooms, and mobile hoists in the home are undertaken on a regular basis to ensure the safety of people using the services in the home. Fire alarm system, emergency lighting system and staff call system were serviced in March 2009. A recent certificate of water for legionnaires test was not available in the home and the Acting Care Manager agreed to check with the Area Manager and to confirm to CQC whether or not this test certificate is available. The records showed that the gas boiler was serviced by a CORGI qualified engineer on 25th March 2009. The PAT testing had been undertaken on 13th November 2008. The temperature of hot water supply in the home is tested regularly and appropriate test records maintained. • However, it was noted that a number of self - closure devices fitted on a number of doors were in need of checking and appropriately adjusting to ensure they close properly to their rebate in order to protect people using the service from the risks of fire. The hot water temperature in a number of hot water outlets including bathrooms and bedrooms taps were tested and found to be between 47 to 48 Degrees C. Appropriate action should be taken to ensure that the hot water supply is maintained at the recommended level of hot water temperature of close to 43 Degrees C at all times. This is to ensure that people using the service enjoy safe supply of hot water without the risk of scalding. • The Acting Care Manager stated that the issues above will be addressed immediately. Service certificates were readily available in addition to risk assessments for safe working practices. The manager confirmed that there are no outstanding requirements made by the Fire or Environmental Health Departments. As previously stated the Acting Care Manager is aware that some staff requiring refresher training in safe working practices, for example, first aid, fire safety, food hygiene and moving and handling. This training is already planned to take place very shortly. People using the service indicated that they feel safe living at the home. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 29 Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 3 X 2 Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP1 Good Practice Recommendations The Acting Care Manager takes appropriate action to revise and update the home’s Statement of Purpose and Service Users’ Guide to reflect the home’s current registration and is made available in the appropriate format and also in line with the recent changes to the Care Homes Regulations 2001 (as amended). The Acting Care Manager takes appropriate action to ensure that the home’s Service Users’ Guide include relevant information on the availability of advocacy service for the appropriate use of people who use the service. The Acting Care Manager takes appropriate action to ensure that the menu is revised in consultation with people who use the service, which offers second choice, and also takes into account their special and health dietary needs. DS0000017179.V376845.R01.S.doc Version 5.2 Page 32 2. OP14 3. OP15 Avis House 4 OP18 The Acting Care Manager takes appropriate action to ensure that all staff receives adult protection and safeguarding training. This is to ensure all staff are aware of these issues and that people who use the service are not at risk of harm or abuse. The Home should take appropriate action to ensure that all staff receives training in Dementia care, equality and diversity, Mental Capacity Act 2005 (including Deprivation of Liberty Safeguards) and mental health needs, in order to fully meet the needs of, people who use the service. The home should take appropriate action to ensure a consistent supply of hot water at a safe temperature at all times. This is to ensure that people using the service enjoy a regular supply of hot water without the risk of scalding. The Registered Provider must ensure that staff who as yet have not received mandatory training and or updates in respect of: • Fire Safety • Health and Safety • First Aid • Moving and handling • Food Hygiene • Infection Control/COSHH do so in order to ensure the safety and protection of people using the service. 5 OP30 6 OP38 7 OP38 8 OP33 The Home should take appropriate action to obtain feedback from stakeholders and visitors to the home on the quality of services and facilities provided to people using the service, as part of the home’s Quality Assurance monitoring systems. Avis House DS0000017179.V376845.R01.S.doc Version 5.2 Page 33 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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