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Inspection on 09/04/10 for 5 Courtenay Avenue

Also see our care home review for 5 Courtenay Avenue for more information

This is the latest available inspection report for this service, carried out on 9th April 2010.

CQC found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Record keeping is very good, and the home has a unique system of record books. Medication storage and record keeping is good. The provision of activities and the organising of day care receive a high priority. The views and interests of residents are paramount, and both residents and support staff speak highly of the home. New residents visit the home several times before they move in.

What has improved since the last inspection?

Requirements made in our last inspection report concerning minor faults with the premises have been dealt with. A new kitchen and dining room was being built whilst we were inspecting the home.

What the care home could do better:

A new resident had been living in the home for one month and although the hospital she was living in provided a partial assessment of her needs, the home had accepted the placement without formally undertaking their own assessment in order to judge whether they would be able to meet those needs (see NMS 2 and 3). Partly because no assessment was undertaken by the home, no written care plan had been created for the new resident. (see NMS 2.4 and NMS 6). Ideally a brief care plan should be created before a new resident moves in so that their assessed care needs can be met from day one. Certainly, the care plan should have been started within those first four weeks. Other residents have `annual care plans` that are agreed at their annual reviews at which they, their relatives, and local authority care manager`s are present. However the care plan we looked at was said the Manager no longer correct as the resident`s needs had changed. In this situation, the written care plan must be reviewed and changed as soon as possible by the home. Any changes can be ratified at the next annual review that has the care manager (commissioner) present. NMS 6.10 says that reviews (by the home) must be at least six monthly, or whenever the resident`s needs change. The title `annual care plan` would be best avoided in the light of this. Although one resident had been risk assessed as `likely to abscond`, the home had not prepared any documentation to hand to the police in this eventuality.

Key inspection report Care homes for adults (18-65 years) Name: Address: 5 Courtenay Avenue 5 Courtenay Avenue Harrow Middlesex HA3 5JH     The quality rating for this care home is:   three star excellent 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: Robert Bond     Date: 1 3 0 4 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 Adults (18-65 years) 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 Adults (18-65 years) 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: 5 Courtenay Avenue 5 Courtenay Avenue Harrow Middlesex HA3 5JH 02084210466 02086217244 winston_mayers@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): T/A Idelo Limited Name of registered manager (if applicable) Ms Diane Morleen Elizabeth Eastman Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category 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: Learning disability - Code LD Date of last inspection Brief description of the care home 5 Courtenay Avenue is registered to provide accommodation to 3 adults who have learning disabilities. Current residents have mental health needs also. The semi-detached house is in a residential area of the London Borough of Harrow and is close to another care home that the company operates. The home is close to transport links and local shops. Although it does not have its own off-street parking it is possible to park in adjacent streets, close to the home. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 3 Brief description of the care home There is one bedroom on the ground floor and two bedrooms upstairs. There are bathing and toilet facilities on both floors. The kitchen and the laundry are on the ground floor. There is also a lounge on the ground floor. A new dining room and kitchen is being built at the rear. Residents wishing to smoke are able to use a building in the garden. The garden is large and includes a patio area, decking and mature shrubs and trees. The office is situated on the first floor. Details of the fees charged for the service are available, on request, from the manager of the home. Care Homes for Adults (18-65 years) 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection at which we assessed the outcomes of the key National Minimum Standards for care homes for younger adults, as published by the Department of Health. In advance of our visit, we obtained from the home a completed Annual Quality Assurance Assessment, and from the residents and staff we obtained completed survey forms. We visited the home on two occasions and spent a total of five hours on site. During these visits we met the Proprietor, the Manager of the home, the organisations Training Manager, various support staff members, and the residents. We looked around the communal parts of the building, and we examined a range of files and documents. Equality and diversity were considered at all times. Care Homes for Adults (18-65 years) Page 6 of 25 Care Homes for Adults (18-65 years) 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 Adults (18-65 years) Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Key documents describing the services the home provides, and the complaints policy have not been kept under review and up-to-date, but they are now correct. The needs of a prospective resident have not been adequately assessed by the home either in advance of her moving in, or during the first month of her placement. The assessed needs of established residents are kept under review. Evidence: On the first day of our inspection, we asked to see the homes current Statement of Purpose and were shown a document dated 2007 that referred to the CSCI and gave the address of their Harrow office that is now closed. We agreed that the home could submit an updated Statement of Purpose to us within 5 days. The homes complaints policy document contained the same historical information. On our second inspection visit, we advised the home of the correct CQC address to quote in these documents, and they were updated there and then. On the first visit we noted that the name of the company on the homes insurance document did not match the name of the company on the registration certificate. This Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: had been corrected on our second visit. One of the homes current residents moved in one month before the start of this inspection. We therefore examined in detail the written information that the home had on this resident, hereafter referred to as the new resident. The information included a discharge summary from hospital, risk assessments from the hospital, and CPA care plan from the hospital. Also present on the file were person-centred nursing plans and a Health Action Plan from the residents previous placement. The Manager confirmed to us that the resident was on a long stay placement with Courtenay Avenue but that the transition phase, as per the homes admission policy, was still taking place as the placement authority had not yet confirmed the placement in the form of a contract. Introductory visits had taken place whilst the prospective resident was still hospital based, and these had been well documented. The Manager told us that some of the information provided by the hospital was not complete, and the hospital had declined to complete the homes referral form. It subsequently became clear that the resident did not understand English as well as had been originally thought. The services of an interpreter were now being considered. The Manager explained that a preliminary assessment of the prospective resident was undertaken by the staff of 5 Courtenay Avenue during her introductory visits, however no formal written assessment was undertaken by the home to ascertain whether they could meet her needs. The home has an assessment document called strength and needs assessment but even one month after admission, the form had not been completed or even started upon. Hence the resident did not have even a basic written care plan set up, despite the provision of care that was taking place. The care file demonstrated that the new resident had a GP arranged and the file contained important telephone numbers, and a photograph of the resident. A front sheet detailing key information about the resident such as full name, date of birth, race and religion, address of next of kin etc, as required by Schedule 3 of the Care Home Regulations was located in the residents Daily Notes book. Care Homes for Adults (18-65 years) Page 11 of 25 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. One of the three residents does not yet have a written care plan. The annual care plan or one resident does not meet his current assessed needs. The National Minimum Standards say that care plans must be reviewed at least six-monthly. Residents views are ascertained and residents are assisted to make informed decisions. Residents are encouraged to assist with domestic tasks within the home. The risk management plans seen are excellent but should be backed up by other documents such as missing person documentation. Evidence: Partly because no formal assessment of the strengths and needs of the new resident had yet been undertaken, no written care plan that referred to her living at 5 Courtenay Avenue was yet in existence. The Manager accepted that a care plan should have been commenced within one month, and offered to start writing one straight away. Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: We were shown care plan documents on both of the other residents. These included a person-centred plan entitled My plan for my life, a Care Plan pen picture that was general, an Annual Care Plan Approach document that was specific, and for one resident only, a daily routine document. The pen picture care plan was neither dated nor signed. However, the Annual Care Plan was signed and dated by the resident, who had commented upon the contents. The Manager said that the contents of this document were in need of review as this residents needs had changed. The Manager told us that residents views were obtained formally at reviews, at one to one key-working meetings, and informally every day. We were also informed that residents are encouraged to keep their bedrooms clean, and help with other domestic tasks, with mixed degrees of success. We were assured that the independence of residents was promoted and this was borne out by the fact that all three residents were out of the house at sometime on both days we visited. The care file of the new resident contained a five point risk management plan. This had been signed and dated by the resident and her key worker. One of the risk elements identified was that of the resident absconding. However no missing person documentation had been put together to hand to the police in this eventuality. Care Homes for Adults (18-65 years) Page 13 of 25 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to join in a large range of stimulating activities within the wider community. Friendships are encouraged, and daily routines promote independence. Residents are offered a healthy food diet. Evidence: Surveys were received from residents that demonstrated they were very well pleased with the lifestyle the home supported them in achieving. One resident wrote, The home treats me very well. On the two occasions we visited as part of this inspection, all three residents were away undertaking activities some of the time, for example one resident had been taken swimming by a member of staff. Each resident has an activity timetable that covers the full seven day week period, Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: which is commended. Good use is made of day care facilities within the area. Use is made of further education opportunities locally. The Manager said the new resiednt would be encouraged to enroll as soon as the new term commenced, which is commended. Residents are able to go to the church of their choice. Residents are give the chance to go on an organised holiday, which is commended. Day trips are also provided, and visiting the gym, going shopping, and attending shows were all mentioned. The home has the use of a minibus which is shared by another nearby home. Some activities are organised jointly, which is commended as a way of promoting friendships. We examined a sample menu that indicated a good variety of high quality meals. One resident cooks ethnic meals that she makes available to the other residents. Care Homes for Adults (18-65 years) Page 15 of 25 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 receive assistance with personal care in ways that they choose. Residents health care needs are met via access to health services in the community. Residents are protected by the good medication administration procedures put in place by the home. Evidence: The two care plans we examined contained details of personal care needs and how to meet them. In one case, the files contained a detailed daily routine to help workers support the resident. Files contained health information, details of health interventions, and residents weight records. The new resident had been already registered with a local GP. We checked the medication storage arrangements and the recording of medication administration which were all in order and well kept. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An excellent complaints procedure, and complaints avoidance process, are in place. Advocates are made available, which is commended. The homes safeguarding policy, and training of staff, promotes the protection of the residents. Evidence: The Proprietor told us that no complaints had been received by the home during the period since the last inspection. We checked the homes complaints procedure in the Service User Guide. It did not give the correct address for the CQC but this was corrected whilst we were present. Residents told us via their surveys, and verbally when we met them that they had nothing but praise for the home and its staff. The Proprietor and all the staff are very hands on in their support of the staff, and hence any potential complaints are dealt with straight away. Advocates for residents are made available as necessary. The Proprietor reported that there have been no safeguarding referrals made by the home during the period since our last inspection. Safeguarding is covered during induction training and in specific in house training. The Manager assured us that all the staff had been trained in safeguarding, and we noted certificates on file to that effect. Care Homes for Adults (18-65 years) Page 17 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 live in a homely, comfortable and safe environment. The bathroom is particularly attractive. The home is very clean and hygenic. Evidence: We toured the premises, except the residents own rooms as the residents were not present at the time. Building work was going on at the rear of the building in that the wooden conservatory was being replaced by a brick built new kitchen and dining room. Communal areas were seen to be well decorated, furnished and clean. We checked that safety certificates were up to date. Care Homes for Adults (18-65 years) 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. The rota demonstrated that there were sufficient staff on duty to support the residents and meet their needs. The home has exceeded the target for NVQ qualified staff, which is commended. The homes recruitment practices protect the residents well. Training needs of staff members are identified and met. Evidence: We checked the homes staffing rota. Of the four support workers employed, three have NVQs in care, and the other is undertaking the award. Training records are in place. We examined in detail the recruitment file of the latest staff member to be appointed. The file contained an application form, two references, a CRB certificate, passport photocopy, training certificates, induction record, personal learning plan, and supervision record. Care Homes for Adults (18-65 years) Page 19 of 25 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 generally well managed home. Three requirements have been made in this report relating to assessment and care planning. Systems are in place to gather feedback on the quality of the service provided. Appropriate health and safety measures are in place to protect residents and staff from harm. Evidence: The Manager holds the Registered Managers Award. She reported that she has a job description, and undertakes additional training as required. We met the organisations Training Manager who is also the Manager of their other care home. She undertakes six monthly internal audits at 5 Courtenay Avenue. Surveys are given to residents and other stakeholders as part of a quality assurance programme. We checked the homes gas safety certificate, six monthly health and safety audit record, fire drill record, latest fire safety report and audit, and the Control of Care Homes for Adults (18-65 years) Page 20 of 25 Evidence: Substances Hazardous to Health records. Care Homes for Adults (18-65 years) Page 21 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 Adults (18-65 years) Page 22 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 1 2 14 The home must straight away begin completing their own written assessment of the new residents strengths and needs. This is so that an individualised written plan of care can be put in place at the earliest opportunity. 01/05/2010 2 6 15 Care plans need to be reviewed and rewritten whenever it is known or suspected that a residents care needs have changed. This is so that a written record of how to meet the current identified needs of a resident is always available for the resident, their representatives, and new support staff to read. 01/05/2010 3 6 15 Each resident must have a service user plan that is based upon an assessment of their needs. 01/05/2010 Care Homes for Adults (18-65 years) Page 23 of 25 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 This is so that from the time of admission their assessed care needs can be met. 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 6 The title annual care plan should be discarded as it implies that care plans last a whole year and are reviewed once a year, whereas the National Minimum Standards require reviews to take place at least every six months. That each resident has a completed missing person document on file that describes them, together with a photograph, and provides key information for the police. The same document could also be possibly used for hospital admissions if health information is included. 2 9 Care Homes for Adults (18-65 years) 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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