Care Home: Avondale Rest Home

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What the care home does well The environment within the home was warm, comfortable, relaxed and friendly. The recent redecoration and refurbishment programme had given the home a bright, airy and pleasant ambiance. The delivery of care was noted to be provided in an unhurried and calm way. Staff were pleasant, attentive and knowledgeable about residents` needs. We noted that staff worked well together as a team. Residents told us that they were frequently consulted about the day to day matters of the home. We noted how well the current outbreak of illness within the home had been managed following consultation with residents. We noted that the manager had effective management monitoring audit tools in place. This had provided a system whereby practices and procedures were regularly monitored and had enabled any shortfalls to be addressed quickly. What has improved since the last inspection? Since the last inspection the manager had reviewed and updated a number of practices and documentation systems within the home. Details of this can be found within the report. The outcome was that the management of the home was more effective. The home had been redecorated, refurbished, re-carpeted/re-floored and a new heating system had been put in. The outcome was that residents were able to live in a comfortable, clean and pleasant environment. What the care home could do better: Within the report some recommendations have been made about a safety risk assessment, ensuring that staff employment history is more detailed, ensuring residents` end of life wishes are recorded and the social activity programme is developed. It was positive to note that the risk assessment and the missing detail on staff files were addressed on the day of the inspection and the other two matters were being managed and in hand. Key inspection report Care homes for older people Name: Address: Avondale Rest Home Leigh on Sea 38 Avondale Drive Essex SS9 4HN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Ann Davey     Date: 2 1 0 1 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 25 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. 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 Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Avondale Rest Home Leigh on Sea 38 Avondale Drive Essex SS9 4HN 01702711934 01702711934 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Avondale Rest Homes Ltd care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 19 The registered person may provide the following categories of service only: Care Home only - Code PC 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 Dementia - Code DE Date of last inspection Brief description of the care home Avondale Rest Home is a care home for up to 19 older people. Some residents may have care needs associated with dementia. The home is situated in a quiet residential area of Leigh-on-Sea and is in close proximity to local shops, amenities and transport links. The home has 13 single bedrooms and 3 shared rooms, all of which have ensuite facilities with the exception of one single bedroom, which is adjacent to a bathroom. The communal space within the home consists of a large lounge, spacious dining room and a conservatory. All areas of the home environment are well maintained and in good decorative order. The fees range between £450.00 - £540.00 Care Homes for Older People Page 4 of 25 19 0 Over 65 0 19 Brief description of the care home per week, depending on the dependency levels of the individual resident, the size and location of the bedroom and the source of funding (private/local authority). Extra services such as hairdressing, chiropody, dental treatment are not included in the fees. Care Homes for Older People Page 5 of 25 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: two star good 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: The last key inspection took place on 19th March 2009. This inspection took place over approximately six hours. The visit started around 9am and finished approximately 3pm. The registered provider is also the registered manager. For ease of reference we have referred to them as the manager for the purposes of this report. The homes current Annual Quality Assurance Assessment (AQAA) which is required by law was still in date. We had requested a new one with a return date of of mid February 2010. The document provided the home with the opportunity of recording what it does well, what it could do better, what had improved in the previous twelve months and its plans for the future. We sent questionnaires to the home asking that they be distributed to stakeholders Care Homes for Older People Page 6 of 25 and returned to us so that we could have an understanding of how residents, staff and health/social care staff felt about the provision. Due to time frames, we had not received any back in time for the inspection. We did however, look at the comments made by residents within the homes own surveys. The comments were positive and the manager had recently sent out further surveys in preparation for their Annual Development Plan. During the day we spoke with the manager, residents and staff. We looked around the home, viewed aspects of various records and observed care practices. We discussed all our findings with the manager. We asked that they took notes so that immediate development work could be started where necessary. We appreciated the co-operation and assistance given to us by the residents, staff and management throughout the day. Care Homes for Older People Page 7 of 25 What the care home does well: 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. Care Homes for Older People Page 8 of 25 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 9 of 25 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 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 can expect to have their needs assessed or identified to ensure that their admission would be appropriate. Evidence: The previous inspection report was displayed in the entrance hallway. The homes Statement of Purpose and Service Users Guide together with a coloured brochure were available from the manager upon request. There was a good selection of useful current publications, pamphlets and items of information and interest on display in this area. The manager told us that the majority of admissions to the home are local people or have relatives who live in the area. We looked at the pre-admission and admission records of two residents who had been admitted to the home since the last inspection. One assessment had been carried when the prospective resident had come to see the home for themselves and the other had been carried out at the local hospital. The Care Homes for Older People Page 10 of 25 Evidence: manager together with another member of staff had carried out the assessments on each occasion. There was evidence that the residents and their respective families had taken part in the assessment process. The assessment records we saw were detailed and comprehensive. We took the opportunity to speak with one of the residents who had recently been admitted. They told us that they had been provided with sufficient information and were made to feel welcome on admission. Care Homes for Older People Page 11 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to receive the level of care required to meet their known assessed needs. Evidence: We looked at six care plans and associated documentation such as risk assessments and daily records. We sampled aspects and elements of these records. Care plans and risk assessments were current and we could see that they had been reviewed on a regular basis. The information within the documentation provided a fair overview and outline of current care needs and requirements. We noted that residents (and relatives) views, wishes and preferences had been recorded. We noted that there was no reference to residents end of life wishes documented. The manager agreed that although this area of care is sensitive, it is important that residents wishes are known and recorded where possible. We noted that current care plans had been left within the dining room area. The manager acknowledged that this was not good practice and undertook to ensure that they are kept within a more secure area.This was addressed by the end of the inspection. Care Homes for Older People Page 12 of 25 Evidence: We observed various aspects of care practice during the day. Care was provided in a sensitive supportive manner and was undertaken in a dignified way. We observed one incident of poor practice where a member of staff transported a resident in a wheelchair without the use of foot plates. This was dangerous and directly contrary to the information within the residents care plan. The manager immediately dealt with the situation and we were satisfied with the outcome. We noted that staff engaged with residents in friendly and natural way whilst undertaking tasks. In the days leading up to the inspection, a number of residents had developed symptoms of the winter vomiting virus. In order to manager the outbreak, the manager had asked all residents if they would stay in their own bedrooms for a few days until the outbreak was under control. The day of our inspection coincided with some of the residents coming out of their rooms for the first time since the outbreak. Some residents had chosen to remain in their rooms. We spoke to individual residents about the arrangement. They all told us that the manager had spoken to them about it and felt it was a good idea and very sensible. They told us that whilst they had been in their rooms, staff were always around...we had drinks all the time...they made sure we had a buzzer to use. We noted that the home maintained a daily record of each residents activity for the day. The entries were informative. The manager told us that the home had a good working relationship with all health and social care professionals. A community nurse was in the home during the morning but unfortunately we were unable to speak with them. We did hear aspects of a conversation they had with the manager about the welfare of a named resident. We noted that the rapport was positive, friendly and in the residents best interest. All medicines were administered by a trained member of staff. We saw training records to support this. The medicines storage facilities were within the dining room. The medicines trolley and storage cabinet had been appropriately secured. We sampled entries within the medicines administration recording system and noted no obvious anomalies. The storage facilities were orderly with no undue overstocking of medicines. Care Homes for Older People Page 13 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a balanced diet and are able to participate in a developing activity programme. Evidence: There was a choice for lunch and we noted that a member of staff was going around speaking with residents about their preferences. We noted that those residents who had been unwell with the virus, were being provided with a suitable alternative of their choice. We spoke with a group of residents who were enjoying a lunch of roast chicken and fresh vegetables. The food looked appetising, was hot and smelt very nice. All expressed complete satisfaction with the choice and quantity of food provided by the home. We noted that tables were laid with clean linen napkins and cloths, place mats and a selection of condiments. The dining area was bright and pleasant. We spoke with two residents about the provision of food and drink whilst they had been unwell. Both spoke very positively about the provision made for them during this period. We noted that there were records in place providing detail of what individual residents had eaten at each meal together with the portion size. The home weighs residents on a regular basis to monitor weight gain or loss. The manager told us that the vast majority of residents have family or friends who Care Homes for Older People Page 14 of 25 Evidence: visit and play a significant part in the social and recreational life of the home. The home employed an activity person for 20 hours a week. The manager acknowledged that the activity programme was limited in content. We noted that there was repeated reference to manicures, chats and quizzes within the activity record. We acknowledged that organised activities do take place on occasions. We spoke with residents about the situation and the response varied from I like what they do...to Id do more if it could be arranged, but Im happy, no grumbles. The manager acknowledged that this was an area of development for the home. We spoke with residents who were in their bedrooms during the time we were there. All expressed the view that they were happy to be there and were enjoying watching television, listening to the radio, reading or doing a puzzle. Some residents had their own telephone. No residents gave us the impression that they felt isolated or bored. We noted that residents in their rooms had direct access to a call bell. We noted that some residents had an active involvement with local churches. There were regular visits to the home by representatives from the local Roman Catholic church and the Church of England. Care Homes for Older People Page 15 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their concerns will be managed appropriately and their care provided in a safe way Evidence: The homes complaint procedure was displayed in the entrance hallway and we noted that there were copies in the Statement of Purpose and Service Users Guide. The Commissions contact details on the procedure displayed within the hallways was out of date and changed by the manager. The manager told us that there had been no complaints since the last inspection. The home had a complaint record log book should this be required. We asked residents about what they would do if they were not happy about something within the home. All told us that they would either speak with the manager or talk to their relative. One resident told us Id just tell them, but never had the need to complain. Another resident told us yes, Id be ok about speaking to xx(a member of staff was named). We spoke to the majority of staff about their understanding of safeguarding vulnerable adults from harm procedures and what they would do if they suspected poor practice. All those spoken with had a good understanding of the matter and confirmed they had received training. Care Homes for Older People Page 16 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in an environment that is clean and comfortable. Evidence: Since the last inspection, many areas of the home had been redecorated, refurbished and re-carpeted. The heating and lighting systems had been updated and a new kitchen fitted. The outcome was that the home was clean, fresh and comfortable. Residents told us that they appreciated the upgrade and we received comments such as we like the new floor...the new chairs are so comfortable and theres different sizes...smells nice. The bedrooms we saw were bright, comfortable and contained items of personal belongings. Some residents had private telephone lines. We noted that residents in their bedrooms had easy access to a call bell. We noted that within the ground floor bedrooms there was an absence of net curtains up at the large windows. The manager told us that when residents are being supported, staff ensure that the main curtains are drawn to maintain dignity and privacy. The visit coincided with a temporary fault with the passenger lift. The situation was being managed well and no resident had been inconvenienced. The communal areas within the home were bright, airy and comfortable. The kitchen and laundry area were clean and orderly. We noted cleaning schedules within these Care Homes for Older People Page 17 of 25 Evidence: areas. Residents had access to an attractive garden area. We noted that there was direct access from the rear courtyard to the main road which could pose a risk to residents. We accepted that residents would not normally use the courtyard area which lead to the laundry. The manager told us that they had plans to secure the area and agreed to put a risk assessment in place until the situation had been resolved. The home is registered to provide care for residents who may have dementia. We noted that there was a lack of orientation or directional change around the home to assist these residents. The manager acknowledged this and explained that the current residents would not benefit from developing this aspect further. The manager told us that each resident admitted would be fully assessed and signage would be improved if it was necessary to meet their needs. Care Homes for Older People Page 18 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for and have their needs met by a team of trained and supervised staff. Evidence: The staff rota was available and the detail on it was clear. The manager confirmed that the staff levels were the same throughout the week including weekends. The manager confirmed that there was a minimum of three staff on duty during the day and two awake members of staff on duty at night. In addition, the manager was rostered along with domestic and cooking staff. The home does not use agency staff and had their own bank of staff to call upon to cover holidays, training and sickness. The home is registered to provide care for 19 residents. At the time of the inspection 18 residents were accommodated. Staff told us that there were sufficient staff on duty to meet the care needs of residents. During the day we made several trips to the bedroom areas within the home and noted that staff were around and attentive to residents in their respective bedrooms. Residents told us staff are always around...somebody always comes if I need help. We looked at the records of two staff who had been recruited since the last inspection. These records were well indexed and orderly. We noted that the employment history of both records was very brief. The manager agreed to address the shortfall within 48 Care Homes for Older People Page 19 of 25 Evidence: hours. Other elements of the records were compliant with regulatory requirements. We noted that the home had a detailed induction programme in place. We saw a detailed matrix of planned and completed staff training. Training certificates were within staff records. We noted that there were records of staff supervision in place. Staff meetings had taken place. Staff told us that they felt supported and enjoyed good training opportunities. Care Homes for Older People Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in a home where their care is managed effectively. Evidence: The manager has an NVQ level 4 qualification in care and we saw from records that they update their training profile on a regular basis. Following the last inspection the manager had reviewed and updated many of the homes policies, procedures and practices as well as implementing new ones. For example, the care plans, risk assessments, medicines and nutritional records had been updated and they had introduced management monitoring audit tools to provide a regular overview of practice within the home. The outcome was that the home was managed effectively and any shortfalls had been noted quickly and addressed. The manager had a hands on approach to the day to day management of the home and this was evident in practice we observed. We saw records to support that residents are consulted about practices within the home. Residents told us were always being asked about what we think...yes, Im Care Homes for Older People Page 21 of 25 Evidence: asked about what I think and we talk a lot here. There was a current Quality Assurance and Annual Development Plan in place. We noted that the manager was in the process of sending out surveys to stakeholders for this years report. The home safeguards residents personal monies upon request. We noted that the record system was well maintained and there was a good audit trail. We sampled three records against the monies being held and noted compliance. We selected and sampled some health and safety records such as fire drills and the fire risk assessment and noted they were current. We selected and sampled some maintenance and service certificates such as the lift apparatus and passenger lift service certificate and noted they were current. Essex Fire and Rescue Service had visited the home in April 2009 and Southend Council were to carry out a routine review of hygiene standards late January 2010. Staff told us that management is good...things are orderly...X is always available and very helpful. Residents told us yes, its managed well...X knows what shes doing...I feel safe here. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 23 of 25 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 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 7 All documentation relating to residents personal information and details should be kept in a secure place at all times. When transporting residents in wheelchairs, staff should note the information on care plans and risk assessments to ensure that the manoeuvre is undertaken safely. Residents end of life wishes and preferences should be sought and recorded whenever possible. The activity programme should be reviewed and developed to ensure that it reflects residents choice and preferences. A risk assessment should be put in place to ensure that the risk of injury from the nearby road to residents who may use the courtyard area is minimal. A full employment history of each staff member should be on file. 2 8 3 4 5 11 12 19 6 29 Care Homes for Older People Page 24 of 25 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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