Inspection on 04/10/07 for 8 Courtenay Avenue

This is the latest available inspection report for this service, carried out on 4th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

8 Courtenay Avenue 29/11/05

8 Courtenay Avenue 10/10/05

8 Courtenay Avenue 16/11/04

8 Courtenay Avenue 22/07/04

8 Courtenay Avenue 25/02/04

Similar services:

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 8 Courtenay Avenue T/A Idelo Limited 8 Courtenay Avenue Harrow Middlesex HA3 5JJ Lead Inspector Tony Lawrence Key Unannounced Inspection 4th October 2007 09:30 DS0000035899.V347371.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000035899.V347371.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000035899.V347371.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 8 Courtenay Avenue Address T/A Idelo Limited 8 Courtenay Avenue Harrow Middlesex HA3 5JJ 0208 428 2339 0208 420 1861 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) T/A Idelo Limited Ms Minna Roach Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000035899.V347371.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2006 Brief Description of the Service: 8 Courtney Ave is a registered care home providing personal care and accommodation for a maximum of 3 people with a learning disability. There are currently two women living in the home and one vacancy. The registered providers are Mr Winston Mayers and Ms Diane Eastman trading as Idelo Ltd. The registered manager is Ms Minna Roach. The Registered Provider also owns another registered care home in Courtenay Avenue. The home is located on a main road that leads into central Harrow. It is close to a bus stop that allows service users access to Harrow’s shops, pubs and other community and leisure amenities. The home is a two storey dwelling with all bedrooms located on the first floor. The building is well set back from the road. All of the bedrooms are single and none have en-suite facilities. The home has gardens to the rear that are well maintained and accessible through the rear conservatory and side extension. The weekly placement fee for the service is determined by the needs of the potential resident and is available from the company’s Business Manager. DS0000035899.V347371.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on Thursday 4th October 2007 from 09:30 – 14:45. The Inspector met and spoke with both of the people living in the home, the owner, manager and care staff. He reviewed the care of both residents by talking with them and staff supporting them and checking care records kept in the home. The Inspector also saw all communal parts of the home and two bedrooms. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000035899.V347371.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000035899.V347371.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has developed a clear information pack to help placing authorities and potential new residents understand what services the home can provide. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. EVIDENCE: During this visit the Inspector spoke with both people living in the home, the owner and manager. The home’s owner told the Inspector that he is working with the local authority’s Social Services Department to identify a third person to live in the home. Some people have visited the home and others have stayed for short periods of respite care, but the owner is clear that a new permanent resident must be someone who can live with the two people already living in the home. The manager confirmed that one of these people has lived in the home since it opened in 2002 and the other person moved into the home in 2005. The Inspector saw that both people had a detailed care needs assessment that had been completed by staff from the home before each person moved in. The assessments covered personal and health care, daily activities, finances, the person’s likes, dislikes and routines, religious and cultural needs. The assessments were used to develop an initial care plan. The Inspector also saw that the company has developed a clear contract / statement of terms and conditions of residence for each person living in the home. DS0000035899.V347371.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home involves people in the planning of care that affects their lifestyle and quality of life. Care plans include a comprehensive risk assessment, which is reviewed regularly. Management of risk is positive addressing safety issues whilst aiming for better quality of life. EVIDENCE: During this visit the Inspector checked the care plan files for both people living in the home. Both people had a current care plan and staff had started to work with individuals to develop a more person-centred Life Plan. These made good use of pictures in a format that made the information more accessible to residents. The home’s care plans and action plans covered all aspects of the person’s life in the home and in the wider community. Staff on duty each day record significant events and these records were evidence that both people are involved in making decisions about their daily lives. During this visit the Inspector saw staff and the home’s Manager offering both residents meaningful choices in a number of areas. The Inspector also saw evidence in each person’s daily care notes that they are fully involved in all aspects of daily life in the home. DS0000035899.V347371.R01.S.doc Version 5.2 Page 9 Both care plan files included detailed risk assessments completed by the home’s Manager and care staff. The assessments covered personal safety, behavioural issues, finances and vulnerability. The assessments had been used to develop agreed strategies for staff to manage identified risks, while maximising each person’s independence. There was evidence that all of the assessments had been reviewed regularly, most recently in March 2007. DS0000035899.V347371.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home have the opportunity to develop and maintain important personal and family relationships, and are able to access information and specialist guidance about issues such as intimate relationships. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. EVIDENCE: During this visit the Inspector spoke with both residents and staff working in the home and checked each person’s care plan and daily care notes completed by staff. Each person had a weekly programme of activities, including use of local day services, activities in the home and the local community. One resident agreed to show the Inspector her bedroom. The room was comfortably furnished and the person had her own TV, computer and music system. The Manager said that both residents chose to spend time together in the lounge, but both also chose to spend time alone in their rooms. One resident told the Inspector that she had been to Florida for a holiday earlier this year, with residents from the company’s other care home and staff. The DS0000035899.V347371.R01.S.doc Version 5.2 Page 11 Manager said that both residents had also had other holidays in France and the UK. While both people’s the existing care plans and Life Plans included some clear goals, staff must make sure that daily care notes are more closely related to agreed goals identified in each person’s care plan. For example, one person’s Life Plan said that she wanted to go swimming and bowling, but there was no evidence in the person’s daily diary that staff had supported her to take part in these activities. Care plans did show that people are supported to maintain contact with relatives and friends. Both residents’ care plans included details of relatives, friends and other significant people. Daily care records showed that both residents have regular contact with people outside the home, including their families. The Manager said that both people visit their relatives most weekends and one person regularly stays overnight. Care plans and records of reviews also showed that people’s personal relationships are recognised and residents had access to specialist support if required. Care plans also considered people’s religious and cultural needs. The home’s owner had involved each person’s family to provide information for care staff on how people’s faith needs are met. The Manager confirmed that both people regularly go to places of worship with their families. Care plans also showed that people are supported to go to an Asian social club and one person went to a performance of an Indian play at the theatre. The Inspector also saw a list of Christian and Hindu festivals on the office notice board for staff reference. Each person living in the home had a weekly menu plan that staff helped them to prepare, based on their known and recorded preferences, likes and dislikes. The menu plans included a variety of nutritious meals, using fresh ingredients. One person is vegetarian and this is reflected in her menu plan. DS0000035899.V347371.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. People living in the home experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ individual plans clearly record their personal and healthcare needs and detail how they will be met. Staff members are very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. EVIDENCE: During this visit the Inspector checked the care plan files for both people living in the home. One person’s file included the record of a review held with the person’s psychiatrist, community nurse and staff from the home in February 2007. The review looked at behavioural and medication issues and set appropriate goals and action plans. The file also included evidence of regular healthcare reviews that had taken place throughout 2006 and 2007, resulting in appropriate referrals to mainstream health care services and clinicians from the multi-disciplinary Learning Disability Team. The file also included a good record of other healthcare appointments, including visits to the GP, dentist and chiropodist. The Manager said that staff keep a monthly record of each person’s weight and appropriate support would be provided if there were a significant weight gain or loss. The second person’s care plan file also included records of regular health care reviews and appropriate referrals to clinicians. The Inspector checked the Medication Administration Record (MAR) sheets for both residents. The home uses the Boots monitored dosage system and all DS0000035899.V347371.R01.S.doc Version 5.2 Page 13 medication is delivered in blister packs each month. Secure storage is provided in a lockable cabinet in the home’s office. Both resident’s MAR sheets were well completed and the Inspector saw no errors or omissions. Staff made good use of codes to record occasions when residents do not take their medication. Both resident’s care plan files included a letter signed by the person’s GP with guidance for staff administering PRN (‘as required’) medication. Both files also included a letter signed by the person’s next of kin agreeing that staff could support people with specific intimate personal care tasks. Care plans also included details of each person’s funeral wishes, based on their faith and agreed with their relatives. DS0000035899.V347371.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. Staff working in the home understand the procedures for Safeguarding Adults and training of staff in the area of protection is regularly arranged by the Home. EVIDENCE: The Manager showed the Inspector a copy of the home’s complaints procedure and confirmed that this had been given to both residents and their relatives. The procedure is clearly written and the Manager said that individual’s key workers would explain the procedure and support people to make a complaint if they wished. No formal complaints have been made since the last key inspection of the home. The Manager and staff told the Inspector that they would use the local authority’s safeguarding adults policy and procedures to report any concerns they had. The potential vulnerability of people living in the home was well recorded as part of their care plans, together with strategies for staff and other people to minimise possible risks. DS0000035899.V347371.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is a very pleasant, safe place to live. The bedrooms and communal rooms provide comfortable and well-decorated accommodation. People living in the home are encouraged to personalise their bedrooms. Shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. EVIDENCE: 8 Courtenay Avenue is a 3-bedroom semi-detached house located on a main road with easy access to bus routes to Harrow town centre. The home is suitable for use as a care home and is indistinguishable from neighbouring properties. Each person living in the home has a single bedroom. The bathroom, toilets, bathroom, communal areas and garden are shared. The home is not accessible to people who use wheelchairs or have mobility difficulties. During this visit, one person showed the Inspector her room and he also saw the vacant bedroom. Both rooms were well decorated and comfortably furnished. Staff had worked with one person to personalise her room with pictures, photographs and other personal belongings. DS0000035899.V347371.R01.S.doc Version 5.2 Page 16 The communal areas were also comfortable and well furnished and offered a variety of spaces for residents’ use. The home has an attractive garden and patio area. All parts of the home seen during this visit were clean and tidy. DS0000035899.V347371.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a team of experienced staff who understand the care needs of people living in the home. Staff undertake appropriate training, including NVQ qualification training. There is a need to make sure that staff do not work excessive hours without breaks. EVIDENCE: The home has a small staff team comprising the Manager and three support workers. The Manager confirmed that one member of staff had completed their National Vocational Qualification (NVQ) Level 2 training. The two other members of the staff team are currently completing their NVQ Training. Staff training records showed that members of the staff team have also recently completed fire safety, health and safety and medication training. The Manager also confirmed that all staff have an Enhanced Disclosure from the Criminal Records Bureau (CRB) before they start work in the home. When the Inspector arrived for this visit, the home’s Manager was on duty. Both residents were at home, with one person leaving for their day service at 09:45. A second member of staff arrived for work at 1:00 pm and the home’s owner also visited the home during the morning. The Inspector was satisfied that this level of staffing was appropriate to meet the care needs and daily routines of both people living in the home. DS0000035899.V347371.R01.S.doc Version 5.2 Page 18 There is a need to review the shift patterns worked by care staff in the home to make sure they have sufficient breaks and days off. This is especially important when one member of staff or the Manager is on leave and cover has to be arranged. A review of the home’s staff rota showed that this has resulted in individual staff working extended shifts with only a few hours break between each shift. It is a requirement of this report that the home’s owner and Manager must review the rota and make sure that staff have sufficient breaks and days off between shifts. DS0000035899.V347371.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 and 43. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Manager has the required qualifications and experience and is competent to run the home. She has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. She works to continuously improve services and provide an increased quality of life for residents with a strong focus on equality and diversity issues. The service has sound policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. EVIDENCE: Information provided by the Manager in the Annual Quality Assurance Assessment (AQAA) is evidence that she is a qualified nurse with many years experience of working with people with a learning disability, in hospitals and the community. She has completed the National Vocational Qualification (NVQ) Level4 Registered Manager’s Award and has been registered by the Commission as a fit person to manage the care home. DS0000035899.V347371.R01.S.doc Version 5.2 Page 20 In conversation with the Inspector, the Manager demonstrated a clear understanding of current best practice and how this could be used in the home to improve the quality of life of both residents. Information provided in the AQAA is evidence that the provider has developed all of the policies and procedures needed to meet these Standards. During this visit the Inspector checked a number of records kept in the home, including both residents’ care plans, finance and medication records, daily care notes, risk assessments and the staff rota. Standards of record keeping in the home are good. The Inspector saw that regular health and safety checks are carried out by staff and recorded. No health and safety issues were noted during this visit. The Inspector saw that the provider has developed a very good format to record monthly monitoring visits to the home, a requirement of Regulation 26 of the Care Homes Regulations. There is now a need to make sure that the monthly monitoring visits take place, reports are written after each visit and copies are sent to the home and the Commission. This will make sure that the excellent standards of care provided to people living in the home are maintained and developed. DS0000035899.V347371.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 4 3 3 3 3 3 3 2 DS0000035899.V347371.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA12 Regulation 15 Requirement To evidence that residents are receiving the care and support agreed in their care plans, staff must make sure that daily care notes are more closely related to agreed goals identified in the plan. To make sure that residents are cared for by an effective staff team, the home’s owner and Manager must review the rota and make sure that staff have sufficient breaks and days off between shifts. To make sure that the excellent standards of care provided to people living in the home are maintained and developed, monthly monitoring visits must take place. A written report must be written after each visit and copies sent to the home and the Commission. Timescale for action 30/11/07 2. YA33 18 30/11/07 3. YA43 26 30/11/07 DS0000035899.V347371.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000035899.V347371.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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