Care Home: Avondale

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What the care home does well People`s needs are assessed before they move into Avondale to help ensure that the home can meet their needs. People`s healthcare needs are met by staff at the home and visiting healthcare professionals. People are supported by a staff team that know them well and that receive regular training for their role. A nutritionally balanced menu is available to people. People know how to raise a concern if they are not happy.AvondaleDS0000006694.V376972.R01.S.docVersion 5.2 What has improved since the last inspection? We saw that improvements had been made to how they record identified risks to individual in the care planning process. Improvements had been made to how medication was being administered and how medication is being recorded. What the care home could do better: They should ensure that people`s care plans and risk assessments contain specific instructions on how a person`s needs are to be met. This would help ensure that people receive the support they require at all times. They should ensure that when decisions are made on behalf of an individual it is done so in the best interests of the person, and that records demonstrate that the Mental Capacity Act 2005, Deprivation of Liberty has been considered in the decision making process. All staff should have up to date awareness training in health and safety. This will help ensure that people are being cared for in a safe manner. Key inspection report CARE HOMES FOR OLDER PEOPLE Avondale 152 New Lane Eccles Manchester M30 7JB Lead Inspector Adele Berriman Key Unannounced Inspection 6th August 2009 10:30 DS0000006694.V376972.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. Avondale DS0000006694.V376972.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 Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avondale Address 152 New Lane Eccles Manchester M30 7JB 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) 0161 707 2303 0161 707 9153 avondale@schealthcare.co.uk Focus Care Centres Ltd Mrs Ayoka Olabisi Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Avondale DS0000006694.V376972.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: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 36. 17th July 2008 Date of last inspection Brief Description of the Service: Avondale provides nursing and personal care for up to 36 older people. The detached premises consist of an older house together with a recent extension. The building is set back from a main road close to shops and public transport; there is a car park to the front and gardens and a patio area to the rear. Accommodation is split over two floors and is comprised of 16 single occupancy and ten double occupancy rooms. The main lounge/dining areas are on the ground floor and a smaller lounge is situated on the first floor. There is a passenger lift to the first floor. Avondale DS0000006694.V376972.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 two stars. This means that the people who use the service experience good quality outcomes. As part of this inspection we carried out an unannounced visit to Avondale on the 6th August 2009. Our visit lasted between 10.30am and 7.15pm. During our visit we spoke to a number of people who use the service and staff, the manager and the area manager for the service. We also looked at a selection of records including care plans, staff records, policies and procedures. During our visit we also looked around several areas of the home. Some time before we visited Avondale the manager of the service completed and Annual Quality Assurance Assessment (AQAA). This document gave them the opportunity to tell us what they did well, things that they thought they could improve, what improvements they had made over the last 12 months and their plans for improvement over the next 12 months. We also asked for some numerical information. The AQAA contained the information we asked for and they sent it to us when we asked for it. Prior to our visit three people who live at Avondale and seven staff completed a survey form to tell us their thoughts on the home. The requirements from the previous inspection had been addressed and there was evidence that the home was continuing to develop the service they provide. What the service does well: People’s needs are assessed before they move into Avondale to help ensure that the home can meet their needs. People’s healthcare needs are met by staff at the home and visiting healthcare professionals. People are supported by a staff team that know them well and that receive regular training for their role. A nutritionally balanced menu is available to people. People know how to raise a concern if they are not happy. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 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 have their needs assessed before they move into Avondale so that they know their needs can be met. EVIDENCE: We saw that people’s needs were assessed prior to them moving into Avondale. The purpose of this assessment was to ensure that the service was able to meet all the needs of the person. They told us that it was the role of the manager of the deputy manager to carry out pre-admission assessments. Information gained during the pre-admission assessment was recorded on a set format that gave the opportunity to record people’s specific needs and wishes related to their day to day living. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 9 They told us that prior to a person moving into the home they were invited to spend some time and have a meal to meet the other residents and staff. When possible, overnight trial stays were also made available. We looked at the pre-admission assessment for two people who had moved into Avondale since we last visited. We saw that important information about the person’s needs had been recorded. Avondale does not provide intermediate care facilities. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. The healthcare needs of people living at Avondale are well managed to help ensure they receive the care and attention they need. EVIDENCE: We saw that each person had their own individual file which contained their care plan, individual risk assessments and personal information. We looked at the care plans of three people. We saw that the care plans gave the opportunity to record people’s needs in relation to their day to day living. The information written in the care plans differed. We saw clear, detailed information in some care plan records. Other records were vague, for example, one record stated “needs assistance by one staff whilst standing” but did not specify what assistance was required. All care plans should give specific instruction as to how a person is to be supported. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 11 We saw that people’s care plans were being reviewed on a regular basis. Information on care plans demonstrated that people had access to local healthcare professionals. For example, we saw records of hospital visits and visits to the home from General Practitioners and district nurses. We saw that information was available from dieticians about how best to support people with their dietary needs. People who completed a survey form told us that they always receive the medical care they need. Individual risk assessments formed part of people’s care plans. These included assessments for moving and handling, the risk of falls, skin pressure areas and the use of bedrails. We saw that they were using a Malnutrition Universal Screening Tool (MUST) to help assess people’s nutritional needs and wishes. We saw one MUST risk assessment that had been wrongly calculated. This gave inconsistent information about the person’s needs. All identified risks for individuals should be reviewed on a regular basis to ensure that people receive the care and support they require. Two people who completed a survey form told us that they always receive the care and support they needs and one person told us they usually did. The majority of staff who completed a survey form told us that they are always given up to date information about the needs of the people they support. Policies and procedures were available for the safe management and administration of medication. The pharmacist dispensed people’s medication to the home in monitored dosage systems which were stored securely in medication cabinets. We saw that a lockable fridge and cupboards were also available for the storage of medicines. We saw two containers containing eye drops were being stored in a cabinet and not in the fridge. To ensure that people receive medication appropriately, all medication should be stored within the manufacturer’s guidelines. Throughout the visit we saw people being supported in a polite and dignified manner. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. People are provided with activities and a variety of home cooked food which they enjoy. EVIDENCE: A member of staff was employed as an activities co-ordinator for 15 hours a week. We saw that planned activities were displayed around the home. Activities available included cookery, reminiscence, sing a longs, games, movie club, a gardening club and a cookie club. Two people told us that there were always activities available for them to take part in. They told us that their plans over the next 12 months were to create a better equipped activity room for people to use. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 13 They told us that outside entertainers visit the home on a monthly basis and that they had arranged for six people to visit Blackpool in the near future. They told us that representatives from local Roman Catholic, Anglican and Pentecostal churches visit the home on a regular basis to support people with their religious beliefs. They told us that they had an open visiting policy and that visitors were welcome at any time. We saw that two people were seated in recliner type chairs that they were unable to get out of independently. We saw that the use of the chair was considered in one of the person’s care plans. We saw no evidence of who had carried out the assessment for the use of the chairs and no information was available to demonstrate that decisions to use the chair had been made in the person’s best interests. Multi-agency assessments should be carried out to help ensure that the use of the chairs is done in the best interests of the individual. Meals were served in the dining room on the ground floor. When we arrived at Avondale we saw that the dining tables were set with menu’s, cups, glasses, cutlery, condiments, napkins and flower table decorations. We observed the cook asking people what their choice of meal was for lunch. The service uses the NUTMEG system for planning menus which is designed to help ensure that people receive a nutritionally balanced diet throughout the day. Two people who completed a survey form told us that they always liked the meals at the home and one person stated that they usually did. Three residents who we spoke to during our visit told us that the food was good and one person said it was “very nice.” Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. People using the service are protected by the complaints and safeguarding procedures. EVIDENCE: We saw that a copy of their complaints procedure was available around the building. The information in the procedure was clear and informed people what action would be taken in the event of a complaint being made. People who completed a survey form and who we spoke to during our visit all told us that they knew who to speak to if they were not happy and all knew how to make a complaint. They told us that they had received no formal complaints since we last visited. We saw that corporate policies and procedures were in place to safeguard people. A copy of Salford Social Services Safeguarding procedures was also available. Training records demonstrated that the majority of staff had undertaken safeguarding awareness training since we last visited. Two of the staff team that we spoke to confirmed that they had received the training and that they had found it interesting. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 15 Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean and comfortable environment is provided. EVIDENCE: A handy person is employed at Avondale to carry out general maintenance and regular testing of equipment. We saw that the building was accessible by a ramped entrance and an internal passenger lift was available to give people access to both floors of the accommodation. We looked around several areas of the home including communal lounges, the dining area, bathrooms and toilets. We saw that since we last visited Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 17 redecoration had taken place of the downstairs corridor, the main lounge and the majority of the bedrooms. We saw that people’s bedrooms were individualised with their own personal effects. They told us that people are encouraged to bring their personal items with them when moving into Avondale to help promote a homely atmosphere. We saw that hoists, grab bars and other equipment was available to support people with their mobility and independence around the home. People who completed a survey form told us that the home was always fresh and clean. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 18 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. The people who live at Avondale are supported by a team of staff who know them well. EVIDENCE: At the time that we visited we saw that one trained nurse and three carers were on duty to meet the needs of the 19 people in residence at Avondale. A cook and a handy person were also on duty to help ensure that all of people’s needs are met. We observed staff supporting people in a manner that demonstrated they were aware of individual’s needs and wishes. People who completed a survey form told us that staff listen and act on what they say and that staff were available when they needed them. Staff who completed a survey told us that there were usually enough staff to meet the needs of people. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 19 We looked at the recruitment files of four staff members. We saw that the majority of the information required was present on the files. This information included completed application forms, written references and evidence that a Criminal Record Bureau disclosure had been completed. One file that we looked at showed us that the person had started their role before both of their references had been returned, another file contained a references that was addressed to “to whom it may concern” and a further file contained an application form that did not contain detailed dates of previous employment. All of the information required for recruitment should be available prior to the member of staff starting their role. We saw evidence of a short induction being made available to staff at the start of their employment. The majority of staff who completed a survey form told us that their induction into their role covered everything they needed to know to do their job when they started their employment. We saw a training matrix that demonstrated that the majority of staff had undertaken training in fire safety, fire drills, food hygiene, safeguarding adults, health and safety and infection control since we last visited. Several staff had also undertaken training in nutrition and the safe handling of medication. We saw that six staff had received moving and handling training since we last visited. A review of moving and handling training within the service should take place to ensure that all staff are aware of how to support a persons safely when moving and handling. All staff who completed a survey form told us that they were being given training which was relevant to their role, that helps them understand and the individual needs of the people they support and that keeps them up to date with new ways of working. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 20 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. The health, safety and wellbeing of people are protected and promoted by the systems, policies and procedures in place. EVIDENCE: Since we last visited a new manager was in post. The manager is a registered nurse and was in the process of completing her application for the role of registered manager with the Care Quality Commission. During the visit the manager demonstrated a good awareness of actions needed to develop the service at the home. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 21 They told us that they planned to carry out their annual quality assurance survey in August and September 2009. We saw comments taken from the previous survey were displayed on the notice board near to the entrance of the building. They told us that regular visits are made to the home by senior managers from Southern Cross to carry out audits on the service. We saw that procedures were in place for the safe management of people’s finances. The service operates an electronic banking system which is linked to Southern Cross finance department who audit the accounts on a regular basis. We saw records to show that health and safety checks are carried out around the building to make sure that people are kept safe. The service had comprehensive corporate policies and procedures to minimise risks to people’s health, safety and wellbeing. We saw that these policies and procedures were readily available to the staff team. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 22 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 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 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 3 X 3 X X 3 Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 23 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 OP7 Good Practice Recommendations People’s care plans should contain specific instructions on how a person’s should be met. Individual risk assessment that form part of people’s care plans should be reviewed and updated on a regular basis to ensure that all known risk and changes to the person situation are considered. Prior to a decision being made on behalf of an individual a multi agency assessment should be completed to show that the person’s best interests had been considered. This is in accordance with the Mental Capacity Act 2005 Deprivation of Liberty. Prior to a member of staff starting their role all information listed in Schedule 2 of the Care Homes Regulations 2001 should be available to the employer. To ensure people receive the care and support they DS0000006694.V376972.R01.S.doc Version 5.2 Page 24 2. OP14 3. 4. OP29 OP30 Avondale require appropriately all staff should have regular training in moving and handling. Avondale DS0000006694.V376972.R01.S.doc Version 5.2 Page 25 Care Quality Commission North West 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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