Inspection on 21/07/09 for The Avenue (44)

This is the latest available inspection report for this service, carried out on 21st July 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Avenue (44) 17/07/06

The Avenue (44) 17/10/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Avenue (44) 44 The Avenue Watford Hertfordshire WD17 4NS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson     Date: 2 1 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Avenue (44) 44 The Avenue Watford Hertfordshire WD17 4NS 01923226946 01923212546 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : CareTech Community Services (No.2) Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 8 44 The Avenue is a residential care home for 8 people with learning diabilty. The registered provider is Caretech Community Services Ltd. The home is located in a residential area close to the town centre of Watford. There are parking spaces to the side of the building, which is a large detached house. On the ground floor there is an entrance hall, lounge, three single bedrooms, bathroom with toilet, kitchen, dining room and a utility room. There are five single occupancy bedrooms on the first floor, a bathroom and two separate toilets. There is also a second floor that is used to provide an office, sleep-in accommodation, bathroom and kitchen. The second floor is used exclusively by staff. There is a small front garden, a larger rear garden that is secure and off-road parking. The fees, which are determined according to the level of care, range from £879 per week. Further information can be obtained from the Statement of Purpose and the Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home Service User Guide. A copy of the CQC inspection report should be available in the home. Care Homes for Adults (18-65 years) Page 5 of 27 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 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 service had a key inspection in July 2007 and an annual service review in July 2008. This unannounced key inspection was carried out on 21/07/2009. The home manager and two care workers were present. There are 7 people in residence. The inspection visit included a tour of the premises and general observation of how the staff interacted with the residents. Both staff and residents were spoken to and key documents were examined. The inspection ended with a thorough discussion with the home manager. Survey questionnaires were sent to the residents and relatives and their responses and other information received by us were reviewed. This included the Annual Quality and Care Homes for Adults (18-65 years) Page 6 of 27 Assurance Assessment (AQAA) which providers of registered services are required to complete annually. The AQAA focuses on how the outcomes are being met for the people using the service and also provides us with statistical data. What the care home does well: What has improved since the last inspection? What they could do better: The service does not have a controlled drug cupboard. Since the inspection, arrangements have been made with the supplying pharmacist to install a controlled drug cupboard as soon as possible. Work is in progress to refurbish the bathroom and toilet on the first floor for the benefit of the people living in the home. The home manager ensures residents safety and ensures that their daily routine is not unduly disrupted while building work is being carried out. The premises have sticky tape used as a hazard warning on the steps at the front entrance, the other doorway within the building and the makeshift wooden box outside the kitchen exit door. The makeshift box is not permanently fixed and may be slippery when wet. It was further noted that the exit kitchen door frame and base are rotten and they need replacing. The tiles at the base of the fire escape to the rear of the building are a tripping hazard and need repairing. It would be good if the provider urgently reviewed the premises and provided an alternative solution to the existing structure which is unsightly and constitutes a safety hazard for the people living in the home. Since the inspection, the new home manager has submitted a requisition to the provider for urgent review and repair work to be carried out. Care Homes for Adults (18-65 years) Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 27 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 10 of 27 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. Prospective clients have the information they need to make an informed choice. A full assessment will be carried out before a prospective client is admitted to ensure that all their care needs can be met. Evidence: There has been no new admission and no change in the number of residents since the last inspection. The last new admission to the home was in 1994 therefore it was not possible to review any recent evidence to support these standards. However, the management assured us that a thorough pre-admission assessment will be carried out should there be an admission. This is to ensure that the home will only admit a prospective client whose care needs can be met. The Avenue is registered to accommodate 8 residents but the provider has an agreement with the funding authority to maintain the number of residents at the current level of 7. Care Homes for Adults (18-65 years) Page 11 of 27 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. People who use the service can be assured that they will have written care plans so that staff will be able to identify their goals and care needs appropriately. This gives the people an opportunity to make everyday choices with staff respecting their preferences and requests and enabling them to achieve independent lifestyles. Evidence: Residents are given the opportunity to participate in the daily routine in the home. They are supported in taking risks as part of an independent lifestyle. The members of staff present were observed to interact well with the residents. Each resident has a written care plan. The manager said that all the care plans are currently being revised using a more user-friendly and person-centred format, introduced by the provider. The existing care plans lack specific details on individual health conditions such as autism and epilepsy. The home manager has agreed to reflect this in the new care plans. The care plans are reviewed monthly. The daily Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: written record on each resident has been kept up to date using a newly designed person-centred format known as My Plan. The members of staff confirmed that they are getting used to the new version. To allow for case tracking and where appropriate, it would be useful to have the signature of the author and the date the information was documented. The home manager has since instructed staff to do so. Appropriate risk assessments were seen in the care plans examined. As one of the residents spends most of their time in the rear garden where there is a car parking area, the home manager has assured that a risk assessment is in place and that members of staff are extra vigilant especially when parking their car to ensure the residents safety. Each resident has a key worker who organises a weekly one to one talk-time meeting to ensure that the resident is consulted and that to the maximum extent possible their views are understood and acted upon. Most of the residents have limited verbal communication. However, members of staff understand their body language and their individual communication style. A full assessment of care needs is carried out annually. This involves all interested parties, including relatives, supporters, healthcare professionals, the social services and the management team. Care Homes for Adults (18-65 years) Page 13 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are encouraged to lead an independent lifestyle and to be engaged in a variety of communal activities in accordance with their assessed needs and they can be assured that their preferences and rights will be respected. They will be encouraged to maintain contact with their friends and family and can be assured that a healthy diet is promoted. Evidence: Residents are encouraged to participate in activities of their choice, and to make use of local leisure facilities. Residents lead an active lifestyle according to their preferences and wishes with support from the staff when required. There is a planned weekly programme of recreational and social activity for each resident. On weekdays most of the residents attend their respective day centres. Alternative arrangements are made for a resident to continue their daily communal activity through one-to-one community Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: support service provided by Life Enhancers. Another resident is taken out weekly by staff from the voluntary organization, Mencaps Leisure Together. On the day of the site visit, three of the residents were at their respective day centres. The management has regular liaison meetings with Day Service providers to monitor residents progress and resolve periodic difficulties that may arise. Staff also encourage and assist the individual with daily living routine such as laundry, cleaning and tidying individual bedrooms. On days when residents do not attend their respective day centre, members of staff will assist them with alternative recreational activities such as shopping, bowling and meals out. Some of the residents regularly attend the weekly Sunnyside Club in Croxley Green on Tuesdays and the Gateway Club in Hatfield on Fridays. Some attend church on Sunday. Staff arrange holidays annually for the residents who are also encouraged to contact family members. Two of the residents visit their parents at weekends on a regular basis. The home offers residents a nutritious and balanced diet. Residents have a menu to choose from and the menu is in picture format. Each member of staff takes turns to cook the meals and residents are given the opportunity to assist in preparing the meals. Care Homes for Adults (18-65 years) Page 15 of 27 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. People who use the service are treated with respect and they will receive personal care and support in the way they prefer and require. They will have access to healthcare services when required and they will be protected by the homes medication policies and procedures, which ensure that medicines will be administered safely to them. Evidence: The two members of staff present on the day of the site visit have a good knowledge of the residents conditions and their likes and dislikes, and deliver care and support accordingly. They interacted well with the four residents who seemed relaxed and content. The home has the support of healthcare professionals such as the family doctor, the dentist, the community nurse and other specialist healthcare professionals. The home has the support of the Community Learning Disability Mental Health Team and residents with behavioural concerns are referred to them for immediate assessment. The specialist nurse on continence issues has visited one of the residents to give their Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: support. A trained member of staff administers medication. The home uses the monitored dosage system and all medicines are stored in a drug cupboard within a storage cupboard. The home has made arrangements to install a controlled drug cupboard. Meantime the temazepam tablets for a resident are kept in a locked metal box and securely locked in the drug cupboard, within a locked storage room. The controlled drug register was correctly maintained. There have been two medication errors earlier in the year. Since then the members of staff involved have had retraining to ensure such errors do not happen again. Additional measures of good practice include an audit by a second member of staff daily. The Medication Administration Record (MAR) charts seen were accurately recorded. Care Homes for Adults (18-65 years) Page 17 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be listened to and that they will be protected from self-harm and abuse. Evidence: Since the last inspection, the home has not received any complaints and there were no safeguarding incidents reported. Staff have had training on safeguarding issues and the homes whistle-blowing procedure. The home follows the joint safeguarding procedure issued by Hertfordshire County Council and a copy of the safeguarding manual is kept in the home. The home manager ensures that all members of staff are familiar with the procedures. Care Homes for Adults (18-65 years) Page 18 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the new management is working towards making the environment more homely, safe and comfortable to live in. Evidence: Since the last inspection, the dining room flooring has been replaced and a new flat screen television has replaced the old one in the lounge. Residents enjoy the improved furnishings in the lounge. The bedrooms inspected appeared fairly tidy and reflected the individual tastes of the residents with personal items on display and comfortable furniture and bedding. The providers senior management team had visited the premises the previous week and there are plans to carry out internal refurbishment and redecoration this year. On the day of the site visit there were two workmen renovating the bathroom and toilet facilities on the first floor. The home manager ensures the safety of the residents whilst building work is being carried out. It was noted that the exit kitchen door frame and base are rotten and they need replacing. The tiles at the base of the fire escape to the rear of the building are a tripping hazard and need repairing. It was further noted that sticky tape is being used Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: as a hazard warning around the steps at the front entrance, the other doorway within the building and the makeshift wooden box outside the kitchen exit door. The makeshift box is not permanently fixed and may be slippery when wet. Since the inspection, the new home manager has submitted a requisition to the provider for urgent review and repair work to be carried out. Care Homes for Adults (18-65 years) Page 20 of 27 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. People who use the service can be assured that the home has an effective staff team who will support them and can be confident that they are safeguarded by the homes robust recruitment policy and procedures. Evidence: The home follows a thorough recruitment process in accordance with the providers defined recruitment policy and procedures. As part of the interview process, the potential recruit is introduced to the residents so that they feel part of the recruitment process. New staff are vetted appropriately. They have to pass the Criminal Record Bureau (CRB) check and the Protection of Vulnerable Adult (POVA) check before they are allowed to start work. The home manager who was recently employed confirmed the recruitment procedure carried out by the provider. On the day of the site visit, a senior support worker and a support worker were present and they were later joined by the home manager. The members of staff were managing well, looking after 4 residents. The home manager herself is new to this service and she confirmed that she is currently going through induction training. Mandatory training for new care staff Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: includes Moving and Handling, Fire Safety, First Aid and Food and Hygiene. Staff training needs have been identified and there are training dates scheduled for the coming months, and evidence of all training is kept in the staff training file. Members of staff interviewed confirmed that they have attended refresher courses and recent training has included Medication, Epilepsy Awareness and the Hertfordshire County Council Joint Safeguarding Procedure. Care Homes for Adults (18-65 years) Page 22 of 27 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. People who use the service can be assured that the care and service provided will continue to improve under the new management. They can be assured that their health and safety are promoted and protected. Evidence: The home has had a new home manager since May 2009. She has yet to apply for registration with us. She is qualified and attained the NVQ4 Managers Award (RMA) in Care and Management in 2004. Since her appointment she has attended some induction training including Managers Fire training and Care Plan training called My Plan. Further training has been organised for the coming weeks. The home manager confirmed that staff supervision records are kept up to date and that all records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. The servicing records have been well maintained. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The provider carries out an annual quality assurance and monitoring survey. This includes written questionnaire feedback from residents, relatives and others. The audit documents were readily available for inspection. There is a monthly proprietors report in compliance with regulations. The Annual Quality Assurance Assessment (AQAA) forms issued by the Commission were received on time for this inspection. The information provided was detailed and has been included in this report. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 20 It is recommended that a controlled drug cupboard be installed without delay as this has been mandatory since 01/01/2008 regardless of whether a controlled drug is in use. This follows the Misuse of Drugs (Safe Custody) Regulation 1973, Amendment 2007. It is recommended that the provider urgently review the premises and provide an alternative solution to the existing structure which is unsightly and constitutes a safety hazard for the people living in the home. 2 24 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!