Latest Inspection
This is the latest available inspection report for this service, carried out on 4th August 2010. CQC found this care home to be providing an Adequate service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for Avon House.
What the care home does well Since the last inspection the home has been working towards meeting the requirements set. Avon House has an acting Manager who has been working to improve care of pressure wounds and this has been greatly improved with good practice and liaison with the tissue viability nurse now in place. A staff nurse spoken with said that residents requiring pressure area care are turned two hourly whilst in bed. This is confirmed by the record chart in the resident`s care plan which also held good records of wound care and fluid balance. All the registered nurses completed training and have further training booked in September 2010 A deputy Manager, who is also a registered nurse, has now been employed though they were not on duty the day of the inspection. A review of the level of dependency for people living in the home has been completed. They used two `tools` to make their assessments of people`s dependency, one in house and one external. The results from these tools say that the current level of staffing is appropriate. Staff have received more training and this is planned to be ongoing though the level and depth of the training needs to be greater to ensure staff possess the necessary knowledge to meet people needs. What the care home could do better: There is an urgent need to put in place a robust system to manage falls and risk assessments with adequate training for staff to ensure the safety of residents at all times. There should be the required number of staff on duty at all times.The staff on duty must be capable of supporting residents at all times whilst on duty therefore the practice of staff working for six , nine or thirteen consecutive twelve hour shifts needs to be stopped. There must be a more robust auditing of care practices,planning, risk assessments and staff rotas so that residents receive safe and timely care. Random inspection report
Care homes for older people
Name: Address: Avon House Allen Street London W8 6BL one star adequate service 20/04/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ann Gavin Date: 0 4 0 8 2 0 1 0 Information about the care home
Name of care home: Address: Avon House Allen Street London W8 6BL 02079373307 02077956288 avon.house@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Grace Corriea Type of registration: Number of places registered: Conditions of registration: Category(ies) : Craegmoor Older People Care Limited care home 35 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 35 The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Eiither whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD The registered person may provide the following category of service only: Care Home with nursing - Code N, to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection 2 0 0 4 2 0 1 0 Care Homes for Older People Page 2 of 12 Brief description of the care home Avon House is a purpose built home, managed by Craegmoor Healthcare, that provides accommodation and nursing care for up to 35 older people. The home is close to the shops and transport links of Kensington High Street. Residents bedrooms are located on all three stories in the home, with lift access to the upper floors. On the ground floor there is an open plan lounge, a dining room, the main kitchen, a conservatory, the managers and administration offices. There are individual small lounges and dining areas on the first and second floors. The home has twenty-six single and four double bedrooms, all with en suite facilities. To the front of the home there is limited off street parking, and a small garden to the rear. Care Homes for Older People Page 3 of 12 What we found:
This was an unannounced random inspection carried out by two inspectors Ann Gavin and Roger James on the 4th August 2010. This visit was made to follow up on requirements from the inspection in April 2010 and the concerns raised following a serious safeguarding investigation. The acting manager and three registered nurses were on duty with six carers.On arrival two of the nurses were on scheduled care planning training which lasted two hours. The care of people on the ground and first floor were looked at through talking with people who live in the home, reviewing care plans and health assessments, talking with staff,observing care practice and looking at staff rotas and complaints. On the day of the inspection there were twenty six residents in the home. Care Planning and Risk Assessments On this visit both inspectors toured the home talking with residents, staff, observing care practice and looked at care plans on the ground and second floor. The general standard of the care plans had improved though it was still difficult to get an overall picture of people, their care needs and social preferences. There were a number of falls reported in the accident book. These stated the facts, for example, X was found on the floor by their bed did not appear to be injured. One of the care plans seen the person had a repeated number of falls all of the same nature. There was a lack of any thorough assessment of why this person was having repeated falls, how these may be prevented, what action was needed to safeguard them. Equally there was no contact made with the falls clinic or other specialist services for advice, nor was there an updated risk assessment. Speaking with a member of staff they said how a resident recently had a fall whilst trying to get out of the chair. An incident form was completed and the residents initial observations were taken. Avon House procedures requires that residents observations are then taken hourly for six hours, then two hourly for 18 hours, but there was no evidence that this was done. There was also no evidence that the care and management of the resident in question was altered in order to prevent subsequent falls occurring. The need for urgent action to put in place a robust system to manage falls and risk assessments and training for staff was discussed with the Area Manger and the acting manager at the inspection. The Area Manager said they would get in contact with the falls clinic and would review practice. The care of people with pressure sores has been totally reviewed and all the registered nurses completed training and have further training booked in September. A staff nurse said that residents requiring pressure area care are turned two hourly whilst in bed. This is confirmed by the record chart in the residents care plan which also held good records of wound care and fluid balance.
Care Homes for Older People Page 4 of 12 A carer was observed taking a hoist in the lift this apparently has happened for sometime. The Area Manager said another hoist was on order. The home must make sure that they have sufficient and suitably assessed equipment to support people safely and in a timely manner. One of the people who have communication difficulties has still not yet had an update on their care plan as to how they best communicate and how best to relate to them when they get aggressive. There was a chart to monitor their behaviour but no plan outlining the action required to pre-empt and to support them. This needs to be addressed urgently. Speaking with a relative they were happy with their care. The Primary Care Trust has paid for training in communication and the manager and one of the registered nurses were due to attend. The manager was unable. The idea is that the registered nurse will cascade this training. This has not happened therefore a date must be fixed. The staff have had one two hour session on communication. However the majority of people living in the home have difficulty expressing themselves therefore a more in depth and thorough training needs to take place and a time planned for the cascade training. Walking around the home people were observed sitting in groups in the lounges looking quite sleepy with no staff around nor any form of stimulation. In one room someone, who would be unable to access any remote controls, was in bed with both the television and the radio on. After lunch the activity coordinator was seen with a group of people looking at ration books and other war time memorabilia and then later a group was involved in baking. All lists of activities have been removed to be updated but there were no notices anywhere of what might happen. There was a volunteer who worked at the home whilst the activities coordinator was on holiday. The Area Manager said that they are interviewing for volunteers. One of the relatives said that at a meeting of relatives and residents last month the need for more groups, individual work and the possibility visits outside the home was discussed. Staffing The home have been recruiting again as they are short three nurses and three carers. One nurse left the previous week. They held interviews at the beginning of this week. They cover vacancies initially with existing staff and bank staff and if they can not find someone to cover the shift the Area Managers approval is ought to access agency staff. Reviewing the staff rotas showed gaps on two occasions for night staff where it appears only one member of staff was working. All the staff work twelve hour shifts. Some staff are working an excessive amount of consecutive shifts. This is poor practice which could put the people in the home at risk as well as the carer. During the inspection on the second floor, the nurse was undertaking care plan training
Care Homes for Older People Page 5 of 12 on the ground floor. Two care assistants were available, although they were not seen for 20 minutes. One care assistant stated that during this time she was in the bedroom of one of the residents, attending to their personal care. This care assistant also stated that the other care assistant went to another floor to assist. Staff spoken with felt supported in their role saying they have access to adequate training. The staff have received a two hour session of the Mental Capacity Act. There was evidence that staff are beginning to use the Act as one person who is refusing their medication is awaiting a mental capacity assessment. It was discussed that a more thorough training is required so as to be draw on the spirit of the act for all residents. All staff have had safeguarding training and more is planned. It is also hoped that some staff will also attend Kensington and Chelsea Social Services Training. The acting manager is being seconded from another Cragemoor service. There is now also a deputy manager in place. Although senior management have been visiting there are still concerns over the level of supervision and internal audits. All care plans and risk assessments and staff rotas were said to have been audited and updated but on inspection there were significant gaps in the robustness of the homes falls management and risk assessments and also gaps and excessive consecutive shifts in the staffing rotas. What the care home does well: What they could do better:
Care Homes for Older People Page 6 of 12 There is an urgent need to put in place a robust system to manage falls and risk assessments with adequate training for staff to ensure the safety of residents at all times. There should be the required number of staff on duty at all times.The staff on duty must be capable of supporting residents at all times whilst on duty therefore the practice of staff working for six , nine or thirteen consecutive twelve hour shifts needs to be stopped. There must be a more robust auditing of care practices,planning, risk assessments and staff rotas so that residents receive safe and timely care. 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 set out on page 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 12 16 The home must be more proactive in supporting people in their social and cultural interests and in enabling them to be part of the local community so that they can have more flexibility and choice over their activities 31/05/2010 2 27 18 The provider must put in place a system that ensures there is adequate staffing cover at all times so that all the health, social and cultural needs of people can be met. 21/04/2010 Care Homes for Older People Page 8 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 13 There must be a full 21/08/2010 assessment of people who may be prone to have challenging behaviour with a clear action plan for all staff to follow so that people receive consistent care which is personalised to their needs. 2 8 13 There must be sufficient and 21/08/2010 suitably assessed equipment to support people safely in their care.The current sharing of hoists between floors must cease in order that people can be safely supported in their care in a timely manner. 3 8 13 A robust assessment and 21/08/2010 monitoring of residents who are at risk of or who have had falls needs to put in place.With adequate training of staff. Preventive measures should be taken when possible. All assessments of risk must be updated once a
Page 9 of 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action fall has occurred with appropriate supports put in place. Ongoing monitoring and professional advice should be sought to provide the best care for residents. and to ensure the safety of all residents at all times 4 27 13 Staff on duty must be capable of supporting residents at all times whilst on duty therefore the practice of staff working for six , nine or thirteen consecutive twelve hour shifts needs to be stopped to ensure that safety of the residents at all times 5 27 13 There must be the required number of staff on at all times and an adequate supervision of the staffing rotas at all times so that residents can be sure of receiving the care and support they require at all times. 6 33 24 There must be a more robust 21/08/2010 auditing of the care practice, care planning, risk assessments and and staff rotas of Avon House to that residents receive safe and timely care. 21/08/2010 21/08/2010 Care Homes for Older People Page 10 of 12 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
