Inspection on 03/11/05 for 126 Cowdray Avenue

This inspection was carried out on 3rd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

126 Cowdray Avenue 09/11/04

126 Cowdray Avenue 07/05/04

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 08/07/2008.

CARE HOME ADULTS 18-65 126 Cowdray Avenue Colchester Essex CO1 1XX Lead Inspector Tim Thornton-Jones Final Unannounced Inspection 3rd November 10:45 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 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 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 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. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 126 Cowdray Avenue Address Colchester Essex CO1 1XX 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) 01206 769478 01206 578696 Mr Daramdeo Ramchurn Mr Daramdeo Ramchurn Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th June 2005 Brief Description of the Service: The service consists of an extended and improved semi-detached house located within a mixed community of residential and commercial premises, and leisure facilities. The three-place care home provides individual bedroom accommodation within a domestic environment, furnished and equipped in a way commensurate with an ordinary domestic dwelling. The service is primarily a ‘home for life’ and persons living at the home are unlikely to move toward a less supported setting. The home is able to accommodate adults who require care and support, with less complex needs, that benefit from living within a family sized environment. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The service is a small terraced house accommodating two service users. The atmosphere within the home is domicile and informal. The day-to-day operation of the home was demonstrated as being flexible and primarily designed around the needs and preferences of the services users. The method of this inspection was via a case tracking approach, although this was limited due to the number of service users accommodated. One service user was at home during the inspection. Records were examined and discussion was undertaken with the Registered Person and one carer, who was at the home for a period during the inspection. Observation of practice was undertaken both directly and indirectly. Access to the community, by service users, was evidenced to some extent, although clearer and more comprehensive records would assist an improved planning and evaluation process. Service users are consulted with about the service and influence the way in which the service is delivered, but this is limited as far as evidence is available. The Registered Person confirmed that if a third service user were to be introduced to the home, existing service users would take a lead as to the suitability of the placement. This is positive and empowering practice. Record keeping remains a weak feature of the service, although various policies and practice procedures were available. Care planning remains at a rudimentary level and there is no evidence to indicate that the documents are used to drive the decision making and consultation process with the service user. Standards associated with staffing, with the exception of recruitment, were weak in terms of compliance and this is mainly associated with staff training and support. The Registered Person would also benefit from further training to update skills and to ensure that the management component to meet National Minimum Standards is achieved. At the time of the last inspection eight National Minimum Standards did not meet the minimum requirement. At this inspection seven remain in need of improvement, although not all of the short falls have been carried forward as not meeting National Minimum Standards at this inspection. Whilst this is a slight improvement, the Registered Person should review progress in meeting National Minimum Standards. Overall, the service achieves a sound outcome for service users, although some recurring standards will need to be improved. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 6 On this occasion twenty-seven National Minimum Standards were considered. Of these twenty met minimum requirements, achieving a compliance of approximately 74 . This is approximately the same compliance noted at the previous inspection. What the service does well: • The home environment continues to provide a homely setting, which is realistic in terms of achieving one of the service objectives of a homefrom-home. The service delivers a sound balance of ‘ordinary life’ principles within the home, being a mix of social, leisure and self-help tasks. • What has improved since the last inspection? • • The overall compliance. care planning has made some improvement toward The beginning of a revised staff supervision system was being used. What they could do better: • • Staff training and development could be improved to help ensure that all carers update their knowledge and skills. The service approach to quality assurance could be improved, although this report accepts that a very low number of service users (two) are accommodated. Care planning has steadily improved but remains in need of further development, particularly with independence and self help skills. • 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. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 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 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 • • Service users benefit from a planned admission process. Service users benefit from the terms and conditions agreed between the home and the service user. EVIDENCE: At the time of inspection two service users were being accommodated, both of whom have been living at the home for a matter of years. The service only accepts referrals from local authorities and the internal procedure is for the home to meet prospective service users within their own living environment to ascertain an initial overview of the person’s needs and aspirations. A transition process then follows until the trial period of three months is completed, at which time the assessment period is completed and evaluated. Following this period a contract is agreed between the placing authority and the service. In addition, a terms and conditions of residency is issued between the service and the service user. The Registered Person is recommended to develop this document in a format that service users will more readily understand. At present the details are explained to the individual and agreed verbally. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 • • • • Service users do not yet fully benefit from the knowledge that their needs and personal goals are reflected within the plan of care. Service users are enabled to make day to day decisions in an appropriate way. Service users benefit from a consultative approach within the home. Service users benefit from the ethos of the home in relation to ordinary life principles, although these could be better evidenced. EVIDENCE: The individual care plans were seen and the inspection concluded that some progress had been made in maintaining adequate records. It is acknowledged that with only two service users being accommodated, care workers have a very good understanding of the needs, preferences and dislikes of each person. Both service users and carers have been involved within the service for some time and the understanding of those who work and live at the home continues to develop and benefit the care outcomes achieved. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 10 The care plans contain aspects of assessment and decision making. Reviews have been undertaken in conjunction with the placing authority as appropriate. The ongoing narrative and the approach taken is under review to ensure that essential information is recorded and is considered in relation to the decisions made within the plan. Some discussion was held between the Registered Person and the Inspector and it was agreed that this aspect of the plan would be reviewed at the next inspection, following a period of trying the revised approach. In summary, the approach favoured a weekly summary of activities and events rather than a daily log. The inspection concluded that service users were, for the most part, enabled and empowered to make decisions on a day to day basis, although it was not possible to ascertain a view from either of the service users on this as they were out for the day or engaged in activities. No restrictions were noted within the care plan, although there was insufficient detail within the plan to demonstrate how individual choices had been made. Service users manage their own finances. No cash was being maintained in safe custody on behalf of either service user. Discussion was held regarding the home’s policy and ethos regarding the way in which service users are consulted on and participate in all aspects of the home. Examples given were that service users contribute to the weekly shopping. There are no planned menus, in favour of a daily decision regarding the main meal. There had been recent discussion regarding the possibility of a third person coming to live at the home. Both service users had been consulted about their views before any decision is made. There are no formal meetings arranged between staff and service users, on the basis that the registered person considers this to be too structured and formal. Preferring to discuss things at mealtimes or at other less formal opportunities. In terms of the home’s overall ethos and philosophy, this approach is appropriate. The ethos of a family style approach to supporting and caring for service users has lead to staff assessing risk in a way that is chiefly intuitive rather than as a planned exercise. Whilst on a day-to-day basis this approach has been effective, the disadvantage is that the home is not able to fully evidence the rational and criterion associated with the decisions made. That said, the risks associated with the daily life of the home are minimal with the characteristics of the care provided being unchallenging in terms of presenting risks of harm. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 14, 15 & 16 • • • • Based upon discussion with one service user, staff and individual records the inspection concluded that service users access appropriate activities. Service users are enabled to access the community for a variety of objectives. Some aspects of relationships would benefit from further development. Service users rights are respected and responsibilities recognised. EVIDENCE: Neither service user accommodated had, by design, a planned and predetermined set of activities throughout the week. The service user present at the inspection expressed a clear wish not to attend a day centre or similar, preferring to take the opportunity of a more flexible approach. The overall regime of the home facilitates this and to a large extent encourages it in a manner reflective of an extended family. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 12 Service users do have opportunity to access the community. The ethos of the service is that of participating in the daily life of the home, and this typically includes contribution to routine tasks such as shopping as well as social and leisure related outings. The latter is driven by service user choice and involvement, although clearer records would demonstrate this more comprehensively. The service reflects a ‘home for life’ policy and service users would benefit from a more organised approach to their self help skills. It was evident that service users do undertake skills and tasks within the home and better recording of these events would further establish an evidential basis for the purpose of the activity. Of the two service users accommodated, one person has made it clear they do not want contact with family members. The second service user has regular contact with family and friends. Again this aspect of the home’s support to service users could be better evidenced within the care plan. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 & 21 • • Medicine arrangements are satisfactory overall. Care planning will need to be further developed to include issues related to end of life issues, illness and aging. EVIDENCE: Very few medicines are maintained and of those that are maintained from time to time the arrangements are well administered and secure. It is important that, when service users are given a choice about controlling their own medicines, arrangements are subject to a risk assessment. The inspection concluded that both service users were happy for the home to assist and support them by maintaining medicines in safe custody. Both service users are relatively young adults and issues of end of life and aging have not been raised. Care plans do include information regarding faith beliefs and related topics. It is recommended that care plans include these topics at reviews, as appropriate. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 • Service users are protected by the home’s policy and procedures associated with complaints and adult protection, although no staff have received training in this regard. EVIDENCE: The home’s complaints procedure meets with National Minimum Standards and is available to service users. The registered person confirmed that copies are provided to families of service users and a summary is contained within the Service Users Guide. The home has a copy of the current policy and procedures of the Essex Vulnerable Adults Committee and the Registered Person demonstrated a sound understanding of the practices and principles involved in the protection of vulnerable adults from abuse. The absence of staff training regarding protecting vulnerable adults is a concern and the Registered Person is urged to ensure that staff awareness is concurrent with current practice and principles. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26, 27, 28 & 29 • The environment is conducive to a homely and domicile atmosphere and reflects the Statement of Purpose. EVIDENCE: Bedrooms of the two service users reflect their personality, were comfortable and included equipment such as television and music equipment. The home has a bathroom and walk in shower facility. The lounge was comfortable and of good size for the number of people accommodated. The overall communal areas were spacious. Neither of the two service users require any mobility or specialist equipment to assist with their independence. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35 & 36 • This group of standards were remaining in need of further development to comply with requirements of National Minimum Standards. EVIDENCE: Care workers had an understanding of the roles and clarity of the work they do and this fits with the Statement of Purpose and care outcomes. Care staff have a good level of experience and have worked at the home for some time. The level of training is low and, whilst the individual knowledge of service users’ needs and preferences is accepted, care workers do need to update their knowledge and understanding. This is an area of weakness within the service. Whilst service users’ needs do appear to be met, this is achieved mainly via professional intuitiveness and experience rather than as a result of training, however, it is accepted that some of the staff, including the Registered Person, supporting service users are, or have been, qualified learning disability nurses. The supervision of staff is improving and a revised system has been introduced, which reflects good practice. This will be examined again at the next inspection, when a larger sample should be available for inspection. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 17 Overall the staffing group of standards remain weak in terms of compliance with National Minimum Standards, although the care outcomes are broadly satisfactory. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39, 40, 41, 42 & 43 • This is a small and informal care home, run on the basis of an extended family approach. This appears to be valued by the service users accommodated. EVIDENCE: The overall ethos and intended outcome for the service is informal and similar to that of an extended family. There is an atmosphere that underpins the feeling that when crossing the threshold, one is entering a person’s own home, which in terms of the care outcomes is a positive experience. The home had started a quality assurance approach, although the Registered Person has been unable to identify a method of evaluation, other than individual reviews of care, since the ‘sample’ is so small, being only two service users. This will continue to be monitored since some progress in this regard is possible. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 19 A tour of the premises was undertaken and records associated with health and safety matters were sampled. No obvious health and safety concerns were noted. A sample of policies and procedures was undertaken and was found to be satisfactory and reflected the home’s practice. There were no comprehensive accounting procedures available and financial management was basic, although commensurate with the size of the service. A petty cash system was used, with various main headings such as food, equipment and furnishings etc. An accountant prepares the annual accounts externally. The home does not hold cash in safe custody on behalf of services users. 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 X Standard3 No 24 25 26 27 28 29 30 STAFFING Score X X 3 3 3 3 X LIFESTYLES Standard No Score 11 2 12 X 13 X 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 2 X X 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 126 Cowdray Avenue Score X X 3 2 Standard No 37 38 39 40 41 42 43 Score X 3 1 3 X X 3 DS0000017717.V264463.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15 Timescale for action The Registered Person must 30/01/06 ensure that care planning takes account of all assessed needs, wants and preferences, with a clear methodology and review of outcomes. This is a repeat requirement. The Registered Person must 30/01/06 ensure that opportunities to develop and maintain independent living skills are planned and recorded within the care management approach of the service. The Registered Person must 30/01/06 ensure that staff have the necessary training and competencies to undertake the job. Each staff must have an individual training and development profile and training record. This is a repeat requirement. The Registered Person must 30/01/06 ensure that staff receive adequate supervision. This is a repeat requirement. Requirement 2. YA11 15 3. YA32YA35 18(1)a 4. YA36 18(2) 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 22 5. YA39 24 The Registered Person must 30/01/06 ensure that a method of quality assurance and quality monitoring is operated. This is a repeat 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 YA5 YA21 Good Practice Recommendations It is recommnded the Registered Person further develops the terms and conditions document to a format that is more accessible and relevant to service users. It is recommnded the Registered Person develops care planning by introducing, as appropriate, matters associated with aging and illness to ascertaining wishes and feelings. It is recommnded the Registered Person ensures that all staff receive training in the protection of adults from abuse. The Registered Person is further reminded that Registered Managers must possess a suitable qualification, to at least NVQ level 4 in both Care and Management. 3. 4. YA23 YA37 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI 126 Cowdray Avenue DS0000017717.V264463.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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