Inspection on 16/09/08 for Tudor Avenue, 3

This is the latest available inspection report for this service, carried out on 16th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tudor Avenue, 3 24/11/05

Tudor Avenue, 3 19/08/04

Tudor Avenue, 3 07/04/04

Tudor Avenue, 3 26/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Tudor Avenue, 3 Hampton Middlesex TW12 2ND Lead Inspector Simon Smith Key Unannounced Inspection 16 September 2008 10:30 th Tudor Avenue, 3 DS0000017395.V364724.R02.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 Tudor Avenue, 3 DS0000017395.V364724.R02.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. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tudor Avenue, 3 Address Hampton Middlesex TW12 2ND 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) 020 8979 2696 e.bruce@richmond.co.uk London Borough of Richmond upon Thames Ann Elizabeth Bruce Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 Brief Description of the Service: 3 Tudor Avenue is home to a maximum of six adults with learning disabilities. The property is owned and maintained by the London & Quadrant Housing Association. The service is managed and staffed by the London Borough of Richmond upon Thames. Residents’ fees are calculated according to their individual needs. The home is situated in a pleasant residential area with good access to local shops and community facilities. The building occupies a corner plot offering gardens to the sides and rear. A good standard of decoration has been achieved throughout the home. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We used evidence from several sources to make this judgement about the home. The inspector visited the home unannounced and spoke to the deputy manager, residents and staff. We also looked at some written records, including residents’ care plans, and checked records of everything the home had reported to us since the last inspection. The home met 31 of 32 National Minimum Standards assessed at this inspection. One standard was almost met. What the service does well: What has improved since the last inspection? What they could do better: Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 6 Archive old information to ensure that staff work with accurate information about residents. Complete the work to improve the pictorial menu board so that residents can use this communication aid. Improve the appearance of the flooring in the communal lounge. 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. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 7 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 Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 8 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): Standards 1, 2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is clear information about the home and the service it provides. Residents’ needs are assessed before they use the service. Each resident has a written contract with the home. EVIDENCE: The home has produced a Statement of Purpose, which outlines the philosophy of care and the aims and objectives of the service. There is a service user guide, which includes information about how to make a complaint. The people that live at the home have a residential care agreement that outlines their rights and responsibilities. All residents have an assessment before they move in to ensure that the service can meet their needs. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 9 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): Standards 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are person-centred and reflect individual needs and interests. Old records should be archived to ensure that staff work with up to date information. Residents receive good support to make informed choices about their lives. The home supports residents in taking manageable risks. EVIDENCE: Residents’ care plans contained good information about individual strengths and needs, likes and dislikes and how care should be delivered. There was evidence that care plans are reviewed regularly to account of any changes in Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 10 need but some of the records on file were out of date and should be archived to ensure that staff work with accurate information. (See also Standard 41). The home is committed to providing a person centred service and there was good evidence that staff support residents to identify, achieve and review individual goals. For example one resident’s goals included aromatherapy, dancercise, hydrotherapy, art, companion cycling, horse riding, visiting friends, going out for meals and to the theatre and attending regular sports events. Staff support residents to make informed decisions about their lives. Residents’ are able to choose the way in which they spend their time and have individual programmes that reflect their interests and preferences. The service involves significant others, such as family members and care managers, where appropriate about residents’ care. The home carries out risk assessments to enable residents to take risks as part of an independent lifestyle. Residents’ files contained risk assessments in areas that were relevant to them. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 11 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): Standards 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ have individual programmes that reflect their needs and interests. Residents have active social lives and are involved in their local community. Residents receive good support to maintain relationships with their friends and families. Residents’ rights and responsibilities are promoted in their daily lives. The home’s menu is varied and designed to meet residents’ needs. EVIDENCE: Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 12 Residents have access to a wide range of activities and opportunities. Some residents join other service users to access sessions such as art therapy and the hydropool. Other residents attend sessions individually with support from staff. For example one resident has recently begun to attend regular concerts. Some residents attend a resource centre each week. Day service staff also visit the home to provide sessions such as Intensive Interaction. Residents’ funding authority recently advised that residents will be given individual budgets to choose and purchase day services. Staff said that the amounts allocated to individual residents vary considerably and that this may affect residents’ ability to purchase the service they want. In addition residential staff will be more involved in supporting residents to access day services in future, which will have implications for the staff team. Residents are actively involved in their local community, making use of shops, pubs, restaurants and other resources. One resident delivers leaflets for his church as he enjoys the involvement in the community this provides. Residents are supported to maintain contact with their families and one resident stays regularly with her family. The home has worked hard to establish regular contact with the family of one resident. Residents’ rights and responsibilities are promoted in their daily lives. Interaction between staff and residents was positive during the inspection and staff addressed residents with respect. Residents are able to choose how they spend their time at the home and to have privacy when they want it. Staff gave examples of how the home has addressed residents’ cultural needs, such as supporting people to attend religious services, celebrate festivals and eat particular foods. Staff said that residents are encouraged to involve themselves in the routines of the home and to take on responsibilities in these areas. For example residents are actively involved in recycling, gardening and shopping for the house. The menu indicated that the home provides a varied and well-balanced diet. Staff said that they aim to support residents in making informed choices about their diet and to promote healthy eating. A pictorial menu board hangs outside the kitchen to enable residents to see what is planned for each meal. Staff said that the original pictures produced for the board had been too small to see clearly and that enlarged images would be available shortly. There was evidence that the home had sought the input of professionals where residents have specific needs around eating and drinking. Residents enjoyed the lunch served during the inspection. One resident chose to eat in the kitchen, a decision which was supported by staff. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 13 Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 14 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): Standards 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer. Residents have access to appropriate health care and treatment when they need it. The home works well with other professionals in making sure residents receive good care. Medication is stored and administered safely. EVIDENCE: Staff on duty had a good knowledge of residents needs. There is good guidance for staff in their work to make sure that residents receive consistent care in the way they prefer. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 15 There was evidence that the home seeks the advice of appropriate healthcare professionals where necessary about residents’ care. For example the home liaises closely with the local community learning disabilities team. A district nurse was visiting one resident regularly at the time of inspection to change dressings following an accident. There was also evidence that residents with ongoing conditions such as epilepsy have access to appropriate care and regular monitoring by specialist professionals. Medication was stored appropriately and there are clear, written procedures governing the administration of medication. Staff who administer medication attend training before they are authorised to do so. All medication coming into or leaving the home is recorded. Medication records were checked and found to be accurate. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 16 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): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place for the management of complaints. Staff attend training in the recognition, prevention and reporting of abuse. EVIDENCE: The London Borough of Richmond has an appropriate complaints policy, which is available at the home. There is also a Whistle-blowing procedure, which enables staff to report any concerns about they have about poor practice. There have been no complaints about the home since the last inspection. The home works within the ‘Joint Policy on Suspected Abuse of Vulnerable Adults’, which provides guidance for staff in the recognition and reporting of abuse. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 17 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): Standards 24, 25, 26, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, safe and well maintained. Residents’ bedrooms reflect individual tastes and interests. Residents have access to specialist equipment when they need it. The home is clean and hygienic. Some parts of the home have been improved since the last inspection and further improvements are planned. EVIDENCE: Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 18 The home is situated in a pleasant residential area and has good access to local community facilities, open spaces and public transport networks. The property occupies a corner plot and has gardens to the sides and rear. The communal rooms on the ground floor include a lounge and separate dining room, both of which have doors to the garden. The carpet in the lounge is stained despite recent professional cleaning. Staff said that the home was considering how best to address this issue. Residents’ bedrooms are personalised and contained evidence of individual hobbies and interests. Bedrooms also contained specialist equipment where necessary, such as adjustable beds and ceiling track hoists. Several areas of the home and garden have been improved since the last inspection. New block paving has been laid at the front of the house, which means that the drive is level. A raised wooden deck area has been installed in the back garden, which staff say is well used by residents in good weather. Staff have supported residents to establish a vegetable plot in the back garden. Further improvements to the home were planned in the near future. A new kitchen will be installed and one of the ground floor bathrooms will be refurbished. One resident’s bedroom has damp on the exterior wall, which will be addressed at the same time. To avoid the upheaval caused by the refurbishment, residents plan to take a holiday in Dorset over this period, supported by staff from the home. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 19 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): Standards 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a stable staff team. Staff communicate well with one another. Staff are appointed following an appropriate recruitment and selection procedure. Staff have access to appropriate training and good support to do their jobs. EVIDENCE: The staff complement for the home is a manager, deputy manager, four support workers and three assistant support workers. There was one assistant support worker vacancy at the time of inspection due to a recent internal promotion. The home employs sleep-in and waking night staff at night. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 20 Most of the staff team has worked at the home for some time. This means that residents’ care is provided by people who know them well. Three staff have joined the home since the last inspection. There is a commitment to providing staff with appropriate training, including support to complete National Vocational Qualifications. The deputy manager said that all three staff employed since the last inspection have completed NVQ level 3 since they started work at the home. Then inspector spoke to the two newest members of staff, both of whom started work at the home in April 2008. Both said that they had had a good induction when they started work and ongoing support to do their jobs. There are good systems of communication amongst staff, such as regular team meetings, handovers between shifts a communication book and a clear shift plan. Staff confirmed that they have regular one to one supervision and an annual appraisal. Staff also said that they have access to training in areas relevant to residents, such as epilepsy and eating and drinking guidelines. Staff files provided evidence that the Council makes appropriate checks on new staff before they start work, including Criminal Records Bureau Disclosure, two references and proof of identity. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 21 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): Standards 37, 38, 39, 41 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team provides good support to the team and enables residents and staff to contribute their opinions. There is a commitment to running the home in residents’ best interests. Old information should be archived to ensure that staff work with accurate information about residents. Health and safety checks were comprehensive and up-to-date. EVIDENCE: Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 22 The manager and deputy manager have worked at the home for some years and form a strong management team that staff say gives them good support. Staff also said that they are encouraged to have their say about how the home is run. There is a commitment to running the home in residents’ best interests and to supporting them in achieving their goals. Residents are encouraged to involve themselves in the routines of the home and are consulted about decisions in the home that affect them. There was evidence that residents’ meetings are held regularly, supported by staff. As highlighted earlier in this report, some of the information held on file in the office is several years old, which made it difficult to find the most up to date records. Old information should be archived, principally to ensure that staff work with accurate information about residents but also to ensure the effective management of the home. There is a fire risk assessment and emergency plan for the home. The last fire drill took place in June 2008. Staff check the fire alarm weekly using different call points. Fire fighting equipment and the emergency lighting system are checked monthly. Records of these checks were up to date. The home has appropriate Employers Liability Insurance. Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 23 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 3 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 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 2 3 X Tudor Avenue, 3 DS0000017395.V364724.R02.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA41 Regulation 17 Timescale for action The Registered Person must 30/10/08 ensure that old information is archived to ensure that staff work with accurate information about residents. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA17 YA28 Good Practice Recommendations Obtain the enlarged images for use with the pictorial menu board so that residents can use this communication aid. Improve the appearance of the flooring in the communal lounge. 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