Care Home: Avondale Residential Care Home

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What the care home does well The home provides a clean, comfortable and homely environment for residents who live there. One visitor said about the home: they are certainly most caring of their clients. What has improved since the last inspection? Since the last inspection there have been improvements to the building and to the garden. Ramps have been installed at both front doors to make the building more easily accessible for residents. A decking and seating area has been built in the back garden and there are some raised flower beds that are accessible for residents who like to garden. What the care home could do better: The home must produce a statement of purpose and service user guide that sets out the aims and objectives of the care home and the facilities and services to be provided for the fees charged. Person centred care planning is being developed and the review and update of residents` care plans must be completed by the end of June 2009. This will ensure that residents` needs are clearly recorded and provide guidance for care staff on how care is to be provided and how risks or events will be managed. The manager is in the process of reviewing medication policies and procedures with regard to residents who can safely self-medicate, the use of homely remedies, and the use of `when required` medication. We have recommended that the home review their policies and procedures in line with guidance produced by the Royal Pharmaceutical Society of Great Britain. The registered person has not met in a timely way, a previous requirement to provide screens in shared bedrooms to ensure that residents` privacy is protected and promoted. We were told that a staff training programme is being developed but there were no records to confirm this. The registered person must demonstrate that staff have the skills, knowledge and competencies to meet the needs of the residents in the home, this must include mandatory training in all areas of safe working practice and specialist training to meet the needs of residents with mental health care needs. The registered person must demonstrate that the home operates thorough and robust recruitment procedures to demonstrate that staff are suitable to work in the home. Recruitment records must be available for inspection. The financial interests of residents must be protected at all times. The registered person must ensure that so far as practicable, staff working in the home do not act as the agent or appointee of residents. The service must have a manager who is registered with the commission. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avondale Residential Care Home 106-108 Radstock Road Woolston Southampton Hampshire SO19 2HU     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Annie Kentfield     Date: 0 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Avondale Residential Care Home 106-108 Radstock Road Woolston Southampton Hampshire SO19 2HU 02380445310 02380445311 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Society of St James care home 15 Number of places (if applicable): Under 65 Over 65 0 15 dementia old age, not falling within any other category Additional conditions: 15 0 The maximum number of service users to be accommodated is 15. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Avondale is located in the Woolston area of Southampton and the home is converted from two semi-detached houses. There are two stairways, one with a stair lift. The home has a good sized rear garden with a decking seating area for residents, raised flower beds and lawns. The building is accessible with a low ramp access to the front door. There are four shared and seven single bedrooms and three shared bathrooms with assisted bathing equipment. Residents have access to two communal sitting rooms, each with a dining area. The home is owned by The Society of St James, a Southampton based registered charity which provides housing and care and support Care Homes for Older People Page 4 of 32 Brief description of the care home services to people who are homeless or vulnerable. The current fees range from 276.71 to 401.94 pounds per week and there are additional charges - details of the fees and additional charges will be in the service user guide. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We made an unannounced visit to the home on 9 April 2009 with one inspector (Annie Kentfield). The visit lasted for 6 hours and we spoke to some of the residents and staff, and the manager. We looked at the communal areas of the home and some of the bedrooms and bathrooms as well as a range of records including care plans, medication records, staff training records and health and safety records. Before the visit we received the Annual Quality Assurance Assessment (AQAA) from the home. This is a self-assessment that gives us some information on what the home does well and where further improvements are planned. We sent surveys to 15 residents, 10 staff and 5 health and social care professionals. Care Homes for Older People Page 6 of 32 Surveys were returned from 3 residents, 2 staff and 2 health care professionals. What the care home does well: What has improved since the last inspection? What they could do better: The home must produce a statement of purpose and service user guide that sets out the aims and objectives of the care home and the facilities and services to be provided for the fees charged. Person centred care planning is being developed and the review and update of residents care plans must be completed by the end of June 2009. This will ensure that residents needs are clearly recorded and provide guidance for care staff on how care is to be provided and how risks or events will be managed. The manager is in the process of reviewing medication policies and procedures with regard to residents who can safely self-medicate, the use of homely remedies, and the use of when required medication. We have recommended that the home review their policies and procedures in line with guidance produced by the Royal Pharmaceutical Society of Great Britain. The registered person has not met in a timely way, a previous requirement to provide screens in shared bedrooms to ensure that residents privacy is protected and promoted. We were told that a staff training programme is being developed but there were no records to confirm this. The registered person must demonstrate that staff have the skills, knowledge and competencies to meet the needs of the residents in the home, this must include mandatory training in all areas of safe working practice and specialist training to meet the needs of residents with mental health care needs. The registered person must demonstrate that the home operates thorough and robust recruitment procedures to demonstrate that staff are suitable to work in the home. Recruitment records must be available for inspection. The financial interests of residents must be protected at all times. The registered person must ensure that so far as practicable, staff working in the home do not act as the agent or appointee of residents. The service must have a manager who is registered with the commission. Care Homes for Older People Page 8 of 32 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 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. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents moving into the home do not receive clear and relevant information about the facilities and services that are provided. The home does not have a staff training programme that supports the stated aim of the service and staff may not have the knowledge and skills to meet the specialist needs of the residents. Evidence: The home has not yet produced a statement of purpose or service user guide. People moving into the home have not been given clear and relevant information about the facilities and services provided by the home or the fees charged. The manager told us that she is in the process of drafting a new statement of purpose and guide for residents, we were told that a copy of the statement of purpose would be sent to the commission when completed but we have not received this. We received three surveys Care Homes for Older People Page 11 of 32 Evidence: from residents and two of these stated that people had not received information about the home before they moved in. The Society of St James has a website that outlines information about Avondale Residential Care Home and sets out what kind of service is offered, this states; The care home caters for vulnerable older people, many of whom have previously been homeless due to their mental health conditions, learning disabilities or substance abuse. Avondale ensures a particularly vulnerable client group receives the quality of care and support that they need. However, some of the comments that we received told us that health and social care professionals are not clear what care needs the service is able to support. The registration for the service does not include the categories of specialist care that the service advertises on the Society website. We looked at the process for assessing the care and support needs of people who move into the home. The manager told us that she is aware that the current assessment form is very focussed on physical care needs and showed us a new person centred assessment form that looks at all of the physical, emotional, psychological and social care needs for new residents, this new assessment form is ready to be put into practice. The manager told us that assessing potential new residents will take into account all of a persons care needs and also consider the care needs of existing residents. The new assessment form will also record what staffing levels would be needed to meet the care needs of new residents. The manager is in the process of setting up a programme of staff training and development. At the moment, there is no evidence that all of the staff in the home have received the training, knowledge and expertise that would be required to meet the needs of residents who have specialist care needs related to their mental health or alcohol use. This means that there is a risk that people with specialist needs who live in the home may receive poor quality of care through lack of trained and knowledgeable staff. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is in the process of developing individual person centred care plans. These will set out the individual care needs of each resident and what action is to be taken to ensure all care needs are met, consistently, but these have not yet been completed. Medication policies and procedures are in the process of being reviewed to ensure that residents receive their medication as prescribed, at all times. The shared rooms do not have screens in place to protect privacy and dignity. Evidence: At the moment the home uses a particular system for recording plans of care and keeping daily records of the care provided. This system is not person centred and focuses on meeting physical care needs. The manager told us that the home is in the process of reviewing all individual care plans and moving to a new system that is person centred. This means that residents will have more involvement in their care plan so that the plan of care reflects not just physical and health care needs but also includes social and personal goals and aspirations. The manager is confident that all of the care plans will have been reviewed and person centred care plans will be Care Homes for Older People Page 13 of 32 Evidence: completed by by mid-May. However, we have made this a regulatory requirement to ensure that all new care plans are completed and in place by the end of June 2009. We looked at three of the completed care plans and overall the emphasis is on keeping active, and the plan of care covers all areas of residents care needs including end of life care. Residents will be asked to confirm and sign their agreement to sharing information in the care plan. Where the care plan identifies any risks to residents, these are detailed in indiviudal risk assessments, with guidance for care staff on how risks are to be managed or minimised. The care plans also include a nutritional screening, continence assessment and regular weight checks will be recorded. The manager is in the process of developing a key worker system and we spoke to one member of staff who told us that the new care plans are very good and they would be working with residents to complete the care plans in the near future. We were told that staff will focus on what residents can do for themselves and their personal preferences and choices. As the care plans are still in the process of being completed we were unable to assess the outcomes for residents and this will be reviewed at following visits to the home. We received comments from two health care professionals who visit the home. Generally, the comments confirmed that staff in the home are caring and the health care needs of the residents are usually met. However, there were also comments on the need for staff in the home to have specialist training in mental health and alcohol issues to ensure that care staff have the skills and knowledge and confidence for meeting the specialist care needs of the residents. One person commented that there is sometimes a problem in arranging for residents to attend the GP surgery for blood tests and other appointments. This was discussed with the manager who told us that these problems have been addressed and residents medical appointments are always recorded in the diary and appointments kept. We looked at the procedures for storing and administering residents medication. Medication is stored in a trolley that is kept locked to the wall when not being used. The manager confirmed that the storage for controlled drugs meets current reguatory requirements. The home does not have any controlled drugs at present but a prescription for temazepam had been sent in error and this will be returned to the pharmacy. The manager told us that the policies and procedures for the safe administration of medication in the home are being reviewed using current good practice guidance for care homes. The policies for self-medication, the use of homely remedies and PRN, or when required, medication have yet to be reviewed and put into place. We looked at how medication is dispensed and recorded and noted that during the morning and lunchtime time periods, two staff were allocated responsibility to dispense and record residents medication. The manager and staff told us that this was a new procedure that had been put into place to ensure that one member of staff was Care Homes for Older People Page 14 of 32 Evidence: able to double check all medicine given and ensure that medication records were correctly updated each time. When we last visited the home in 2008 we made a regulatory requirement for suitable screening to be provided in the four shared bedrooms, this was also highlighted as a lack of privacy for residents in 2007. This requirement has not been met. However, the manager told us that since being appointed in November 2008, she has asked the residents if they would like to have ceiling curtain tracks fitted that would provide permanent screens. We were told that residents have said they would prefer temporary and moveable screens. The current moveable screens that are see through, are being covered with opaque material to provide residents with privacy when they choose this. However, we identifed lack of privacy as a concern in 2007 and 2008 and this concern has not been addressed in a timely way. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a varied and balanced diet of good quality and freshly cooked meals. The opportunities for social, recreational and leisure activities are limited. Evidence: We received comments from three residents in the surveys and these stated that the meals in the home are always good. One person made a request for salmon sandwiches to be on the menu. We spoke to two residents who told us that the home always offers alternative meals if there is something on the daily menu they do not like or want. The home employs two cooks who prepare and cook meals in the home each day using fresh ingredients. When we visited the cook was preparing the lunchtime meal and also making cakes for afternoon tea. Meals are usually eaten in the two dining areas but residents can have their meals in their room if they want to. Three of the residents told us that there are not enough activities arranged by the home; one person said - could do with more. Another person said - I wish there was more for me to do, I get fed up with just TV. We only have one couple who come to Care Homes for Older People Page 16 of 32 Evidence: entertain us with music, some fresh air would be nice!. A member of staff told us that if they have time they will do games, quizzes or bingo with the residents. The manager told us in the Annual Quality Assurance Assessment that the home plans to increase the activities that will be offered. The manager told us that the home recognises that residents need to be consulted on what activities they would like to be doing. We were told that there are plans to delegate two members of staff to coordinate social activities including outings and trips. The manager told us that the home has asked some of the local religious groups to visit the home to provide residents with the opportunity for religious worship if they wish. The manager told us that she is awaiting confirmation of this. Since the last inspection the garden has been improved with a decking and seating area for residents. Raised flower beds have been built as some of the residents like to garden. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously and responded to appropriately. The home has a policy and procedures for safeguarding residents from the risk of abuse, however, there are no records available of staff training in safeguarding issues and awareness. Evidence: The home has a complaints policy and this is on display in the entrance to the home. Information about the manager of the home and how people contact the Commission if they want to, is out of date. We received a complaint about the home in December 2008. This was investigated by the responsible individual and we received a letter with details of the outcomes. The complaint was anonymous and the allegations were investigated thoroughly and promptly by the service. The manager told us that one other complaint had been received and this had been investigated and action taken. The manager told us in the AQAA that all staff have received safeguarding training, however, we were unable to confirm this as records of staff training were not available to look at. Care Homes for Older People Page 18 of 32 Evidence: Surveys received from two residents stated that they would speak to a member of staff if they had any concerns or complaints. The manager told us that some of the residents are able to manage their own finances and some residents have support from family or an independent resource. However, some of the residents are unable to manage their own finances and staff in the home provide assistance with financial transactions. This means that the home holds hold bank cards and pin numbers for residents. The manager told us that the home is aware that this is not safe practice and would be looking at ways to ensure that residents are either independent or receive independent advocacy. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes provides a clean, comfortable and homely environment for the residents. Some areas of the home need decoration and refurbishment and this work is being planned for the near future. Action is taken to ensure that practice in the home safely manages the control of infection or the risk of cross infection. Evidence: The areas of the home that we looked at included all of the communal areas, the kitchen, bathrooms and toilets, laundry and some of the bedrooms. The home was clean and pleasant and comments from residents confirmed that the home is always clean and free from unpleasant odours. The manager told us that the home is now using an ecological cleaner that works particularly well with any bacteria or odours of urine and the product is chemical free and non-toxic. The manager told us that the product is safe to use if residents have any allergies or respiratory problems. During our visit we saw staff cleaning toilets and bathrooms and staff told us that they check these during the day to ensure that toilets and bathrooms are maintained in a clean and hygienic way. The Annual Quality Assurance Assessment stated that the home has a policy and procedures in place to control infection and reduce the risk of cross infection. We noted that bathrooms and toilets had suitable hand washing facilities in place and staff confirmed that they have access to gloves and aprons as needed. Care Homes for Older People Page 20 of 32 Evidence: Residents have two sitting rooms, each with a dining area. The home environment is homely and comfortable. However, some of the decoration, furnishing and flooring is looking worn and tired. The manager told us that there are plans to decorate one of the living rooms and replace the lighting and carpeting. The manager told us that residents would be consulted about colours and curtains and furniture. Four of the bedrooms are shared rooms, although one shared room currently has one person in it. Other bedrooms are single occupancy. The shared bedrooms do not yet have suitable screens to provide privacy for residents. This issue has been raised at two previous inspections and is only now being addressed. The mesh screens currently in use are being covered in opaque fabric to provide privacy when residents want this. We spoke to two residents who were sharing a room. They told us that they are satisfied with the home and the service provided. Since the last inspection the home has fitted ramps at both front doors to provide easier access for residents. The Annual Quality Assurance Assessment also stated that a new boiler has been installed and in the kitchen, agreement has been made to install a new cooker. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home recognises the importance of staff training but there is no recorded evidence of a staff training and development programme in place. The home does not demonstrate that staff have the skills and knowledge to meet the specialist needs of the residents. Records to demonstrate that the home operates thorough and robust recruitment procedures were not available for inspection. A record of the staffing rota was not available. Evidence: Although we were told in the Annual Quality Assurance Assessment that the home has a robust staff recruitment policy, and we spoke to a new member of staff who confirmed that the home had requested a criminal record check before employment, there were no records in the home to demonstrate this. The manager told us that all records related to staff recruitment are kept by The Society of St James, in another office. Without documentary evidence of the staff recruitment checks the home does not meet the requirements of the Care Homes Regulations 2001 and cannot demonstrate that staff are suitable to work in the home with the residents. The manager told us that the home uses staffing ladders to ensure that there are sufficient staff on duty to meet the needs of the residents. However, there was no record of a staffing rota. The daily records of staff on duty are written into the homes Care Homes for Older People Page 22 of 32 Evidence: diary. The diary shows that there are usually three care staff on duty from 8am to 2pm, with 2 care staff from 2pm until 9pm. In addition the home employs a manager, cook, cleaner and administrator. The manager told us that the Society of St James supplies a support worker on 5 days per week but the recruitment records for this person were not available in the home. At the moment, some of the shifts are being covered by agency staff until new staff are appointed. As there was no staff rota there was no record of the hours worked by the manager, what the on call arrangements are when the manager is not there, or who is in charge of the home when the manager is not there. We spoke to a member of staff who confirmed that they had already achieved a National Vocational Qualification (NVQ) in care, level 2, in their previous employment. The member of staff also confirmed that their training in safe moving and handling was up to date from their previous employment. The manager told us that she is in the process of developing a staff training programme and plans to ensure that all staff will have completed the NVQ level 2 in care by the end of 2009. However, records of staff training, completed or planned were not available for inspection. The home does not have a clear statement of purpose although there is evidence from the Society website that the home aims to provide care for people who need care related to long term mental health problems, or long term drug and alcohol use. The home does not demonstrate that staff in the home, individually or collectively, have the skills and competencies to meet these specialist care needs. This means that residents may be at risk of their care needs not being met, or not being met consistently and competently. Discussion with the manager demonstrated that the manager is aware of the need to demonstrate a suitable and consistent staff training and development programme. The manager told us that she is in the process of arranging staff training, including end of life care and mental health training. The manager told us that she aims to also provide support and training for staff to develop language and communication skills if needed. The manager was not able to provide evidence that staff in the home have completed training in all areas of safe working practice such as safe moving and handling, health and safety, food hygiene, infection control, first aid and fire safety. The Annual Quality Assurance Assessment stated that plans for improvement over the next 12 months included: completing NVQ training and developing a structure to the team and ensuring that the training and supervision of staff development and knowledge base will ensure we are meeting residents needs. The AQAA tells us that 4 out of the 10 staff hold an NVQ (National Vocational Qualification) level 2 in care. Feedback from residents and staff confirmed that the home is friendly and homely and one member of staff told us that the home is a lovely place to work and the staff team Care Homes for Older People Page 23 of 32 Evidence: is good with low staff turnover. A health and social care professional who visits the home commented that the staff are very caring, however, also commented that staff would benefit from more training, particularly in mental health care. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A manager has been appointed but the manager is not registered with the Commission. Some of the policies and procedures to safeguard the residents health and well being are in the process of being developed but are not yet embedded in practice in the home. Evidence: The previous manager left in August 2008 and the home was managed on a temporary basis until the current manager was appointed in November 2008. The manager has previous management experience and plans to obtain a relevant qualification in care and management. The manager told us that she had been enrolled to achieve the NVQ 4 in care and the NVQ 4 Registered Manager Award, in her previous employment, but had deferred completing this until a later date. The manager understands person centred care planning and is in the process of reviewing and developing the care planning system in the home. The manager is Care Homes for Older People Page 25 of 32 Evidence: aware of working to improve outcomes for residents in the home and is working with staff to develop person centred care. The manager told us that since being appointed she has become aware of the need to develop systems for managing the home that were not in place. The manager told us that priority has been given to developing person centred care planning and ensuring that health and safety is promoted. The manager told us that she plans to develop a quality audit system to monitor how the service is meeting the needs of the residents and complying with the Care Homes Regulations 2001. The manager plans to develop ways of seeking feedback from the residents about the service and also include feedback from visitors and staff. However, although the home has not had a registered manager for nearly 12 months, responsibility for ensuring the service is compliant with the regulations at all times, is with the responsible indiviudal who acts as the representative of the registered providers. The responsible individual told us in February 2009 that an application to register the manager would be sent within the next few weeks, but we have not received this. The home does not have a statement of purpose that sets out the aims and objectives of the service. However, the Society website states that the aim of the service is to provide care for people with mental health or previous alcohol problems. The home does not demonstrate that staff have the skills, knowledge or competencies to meet these specialist care needs, although we have been told that the home is developing an appropriate staff training and development programme there were no records to support this. Lack of staff training may put residents at risk of their care needs not being met or not met consistently. Records were not available to demonstrate that suitable checks have been obtained for new staff working in the home. This is a regulatory requirement and evidence of records of staff recruitment must be kept in the home and be available for inspection. Records were not available to demonstrate that staff are competent in mandatory areas of training for safe working practice. This means that staff may not have the skills and knowledge to work in ways that are safe for the residents and staff, such as safe moving and handling practice. Other aspects of health and safety have improved since the last inspection: up to date records were seen for fire alarm and emergency lighting testing, fire safety risk assessment, and servicing of fire safety equipment. The electrical systems have been checked and the manager told us that she is planning to instigate a system for regularly checking the alarm call system in the home. The systems for managing small amounts of residents monies are in place and all Care Homes for Older People Page 26 of 32 Evidence: transactions are double checked and regularly audited. However, some of the residents are not able to manage their own finances and a member of staff holds cards and pin numbers. Although we were told that all transactions are double checked and audited, this is not safe or recommended practice, and is not in the best interests of the residents. The manager told us she is aware of this and would like to have a different system in place so that residents are either independent or are supported by an independent advocate to manage their financial affairs. The manager told us that the home plans to provide training for staff on the mental capacity act but no training records were available for inspection. The Annual Quality Assurance Assessment was completed by the manager and the information gives a reasonable picture of the current situation within the service. The AQAA provides some information about the areas they still need to improve but only briefly explains what they plan to do and does not provide timescales of when improvements will be in place, and regulatory requirements met. The AQAA states that Avondale has a fully comprehensive equality and diversity policy but does not provide evidence of how this is promoted in practice in the home. Care Homes for Older People Page 27 of 32 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 24 12 Suitable screening must be provided in double rooms. This is to ensure privacy for personal care. 31/05/2008 Care Homes for Older People Page 28 of 32 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, Care Homes 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 1 4 The registered person must 30/06/2009 have a statement of purpose that sets out the aims and objectives of the care home and a service user guide with details of services and facilities to be provided, including fees. People using the service must have access to a statement as to the facilities and services which are to be provided by the care home. 2 7 15 Residents must be consulted 30/06/2009 and a written care plan be provided as to how residents needs in respect of health and welfare are to be met. The person centred care plan must be available to each resident and be kept under review to reflect changes in care needs. 3 10 12 There must be suitable 30/06/2009 arrangements to ensure that Page 29 of 32 Care Homes for Older People the care home is conducted in a manner that respects the privacy and dignity of the residents. Residents in shared bedrooms must have suitable screening to ensure privacy when required. 4 29 19 The registered person must 30/06/2009 demonstrate that staff are suitable to work in the home with the residents. The home must provide evidence of suitable staff recruitment procedures as specified in Schedule 2 of the Care Homes Regulations 2001. 5 30 18 The registered person must demonstrate that at all times suitably qualified and competent staff are working in the care home. The home must demonstrate that staff working in the home receive training and support appropriate to meeting the needs of the residents living in the home. 6 35 20 The registered person shall ensure so far as practicable that persons working at the care home do not act as the agent or appointee of a service user. The financial interests of residents must be safeguarded at all times. 30/06/2009 30/06/2009 Care Homes for Older People Page 30 of 32 7 37 17 Records must be kept up to date and be available in the home for inspection by any person authorised by the Commission to inspect the care home. Residents rights and best interests must be safeguarded by the homes record keeping, policies and procedures. 30/06/2009 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 1 9 Review the polices and procedures for the safe administration of residents medication in line with current good practice guidance produced by the Royal Pharmaceutical Society of Great Britain. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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