Inspection on 28/06/05 for 151 Tunbury Avenue

This inspection was carried out on 28th June 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 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

151 Tunbury Avenue 20/01/10

151 Tunbury Avenue 01/10/07

151 Tunbury Avenue 11/07/06

151 Tunbury Avenue 15/12/05

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

CARE HOME ADULTS 18-65 151 Tunbury Avenue 151 Tunbury Avenue Chatham Kent ME5 9HY Lead Inspector Sue McGrath Announced 28 June 2005 9.30am 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 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 Stationary 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. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 151 Tunbury Avenue Address 151 Tunbury Avenue Chatham Kent ME5 9HY 01622 769100 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) MCCH Society Limited Aaron-Jan Marshall Care Home 3 Category(ies) of Learning Disability (2) registration, with number Learning Disability - over 65 (1) of places 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: 151 Tunbury Avenue is one of a number of homes managed by MCCH Society Ltd. This organisation took over the management of this home on 1st April 2005. The home offers 24-hour care for service users with a learning disability. It is located within a pleasant residential area. It is a large detached bungalow with shops and local amenities close by. The home benefits from transport that is shared between several homes from that group. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 28th June 2005. Two inspectors were in the home and the main focus of the inspection was on the general environment and the well being of the residents. The home has recently changed providers with MCCH Society Ltd now being the registered provider. During the inspection documentation and records were read, including care plans. A tour of the building was undertaken and all of the resident were spoken to. Many judgements about the quality of life for residents were taken from observations, speaking with staff, reviewing records and from direct discussion with service users. What the service does well: What has improved since the last inspection? The manager has identified resources for funding a new improved bathroom, which will enhance the quality of facilities for both service users and staff. The manager has also identified some shortcoming in the laundry area for which he is drawing up plans to improve facilities. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4,5 Prospective residents are not currently provided with the information they need to make an informed choice about moving into the home. Residents’ benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Residents and families also benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. Resident’s legal rights to occupancy are not currently protected by a written statement of terms and conditions. EVIDENCE: Due to the recent change of provider the homes does not have a Statement of Purpose or a Service User Guide. Time was spent with the manager discussing the format and contents of any proposed documents. This was not seen as a deliberate attempt not to comply with the regulations, but clearly these documents must be produced and approved as soon as possible. The assessment process was discussed, as the home had not had any new residents for some time. The manager was aware that MCCH had a formal admission process and although there had been no new admissions recently was able to discuss the process he would use if a prospective service user applied. This included undertaking a full assessment with information gathered from Care Managers, families and in discussion with the service user. A phased admission would take place included several visits and an overnight stay. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 9 Other service user living at the home would also be involved with the process. The processed discussed would provide the home with adequate information on which to make a judgement over whether they could meet the prospective residents needs. Again due to the recent change of provider the current service users do not have a written contract or a statement of terms and conditions. The manager was confident that this issue would be dealt with before the next inspection. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 6,7,8,9,10 Service users have clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Care plans are regularly updated to ensure changes are recorded and acted upon. Service users are enabled to take reasonable risks within the homes risk assessment management strategies. Service users privacy is protected by a confidentiality policy that staff are familiar with. EVIDENCE: Some of the Residents were involved with drawing up their care plans but some did not have the capabilities to be fully involved, where this was the case other professionals were involved including Care Managers and Epilepsy experts. A key worker system was in place with a specific support workers being allocated for each service user. It was observed that one of the service users was involved with all reviews. All of the care plans were reviewed and updated to reflect changing needs on a regular basis. The paperwork to 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 11 confirm the changes needed to be completed in the care plans. These changes were discussed at regular staff meetings and staff signed to say they were aware of the changes. The plans were seen to identify individual procedures for managing the behaviour of the Residents and gave clear guidance to staff. The care plans contained comprehensive risk assessments, which were regularly updated. The manager was aware that service user should not be restricted to the extent that daily activities were heavily restricted due to potential risks. During the course of the inspection, staff were seen to interact well with the residents and were observed encouraging residents to make choices. Where residents were unable to make informed judgements staff were seen to be supportive and caring. One service user in particular was very pro-active in being involved with all the decisions around her and was particularly observant with her finances. Evidence was seen that monthly residents meetings were held to endeavour to try and find out what the service user wanted to do. Advise was given to record the outcomes of these meetings to ensure their wishes were met were possible. All of the information held on the service user was secure and available only to staff and the individual. The manager confirmed that confidentiality was part of the initial induction of staff and an ongoing subject at supervision. Formal Policies and Procedures regarding confidentiality were in place. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 11,12,13,14,15,16,17 Resident’s benefit from having the opportunity for personal development with their daily living skills and have appropriate level of leisure activities. Residents also benefit from being part of the local community. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The resident’s benefit from the appetising meals and balanced diet offered by the home. EVIDENCE: It was evident that all of the service users were treated as individuals who all had different aspirations and activities were arranged accordingly. One of the service users enjoyed cookery and although the home had been unable to obtain a placement at college, she was given weekly instructions by an in house tutor and she regularly assisted with the preparation of meals within the home. This service user also enjoys practising her written english and maths and was very successful. The remaining two service users were unable to further their education due to the level of their disability, but they did have a 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 13 busy activity schedule. These activities were often done as and when the service user wished them, rather than on a weekly programme. This appears to suit this group better. All activities were recorded and took place during the day, or at evenings and at weekends. One service user considered that the weekends were her ‘days off’ and often just wanted to spend time relaxing in the home. The manager stated that the neighbours were really supportive and that one regularly brought in a dog for the service users to enjoy contact with. The home had tried to have their own pets but this had not proved successful. Outside activities included days out, trips to the pub and visits to shows, bingo and shopping trips. A curator from Rochester Museum had recently visited the home for some reminiscence work and this had proved popular. If the GP gives permission service user can have alcohol during trips to the pub. Visitors were encouraged at all times, with the dining room or bedrooms used if they wish to visit in private. All visitors are recorded in the daybook. The home is considering having a visitor’s book so that comments from visitors can be recorded. One of the service user said she enjoyed writing letters to her friends. With regards to holidays this year one service user told the inspectors that she preferred to go out for days as she does not like staying out overnight. A weeks holiday is currently being organised for the other two service user who enjoy going away together. The daily routines and house rules were seen to promote independence where possible and respected individual choices and freedom of movement. Staff were seen to communicate appropriately and affectively with the service user and interacted well with them. Menus were in place and were regularly reviewed by the staff and Residents. Staff had encouraged one service user to attend a diet club and she had succeeded in losing a considerable amount of weight. This service user was fully involved in the preparation and planning of her food and was very pleased with her weight loss. Pureed food was prepared for one of the service user and this was presented in a pleasing way. If necessary service user were seen by the Speech and Language therapist to ensure swallowing problems were being handled correctly. It was evident that plenty of fresh fruit and vegetable were available and the cupboards were well stocked with food. The service users enjoyed a weekly take away evening as part of their activities. Assistance to eat was given in a supportive and caring manner. One service user said the food was ‘very nice’. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20,21 Service users benefit from being provided with sensitive and flexible personal support. Health needs are met and service users benefit from having full access to all professional health care services as required. Service users are protected by the home’s policies and procedures for dealing with medicines. Staff deal with ageing and illness in a sensitive and respectful manner. EVIDENCE: Staff were seen to be sensitive and respectful to the service users and helped them to achieved as much independence as was physically possible for that individual. The manager stated that all personal care was provided in private and that time for getting up and going to bed was entirely up to the individual service user. Daily notes confirmed this was the case. Choice was given over what clothing to wear. Where choice was not possible staff ensured appropriate clothing was worn. All of the Residents were registered with a local GP and had full access to all NHS healthcare facilities as required. One service user was prone to having pressure areas but vigilance from staff and effective pressure relieving equipment assisted greatly in preventing regular problems. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 15 The homes administration of medication was assessed and the manager was disappointed to find that systems he had put in place were not being followed resulting in over ordering and a lack of stock rotation causing medication to be used out of order. The fact that the manager does not spend as much time in the unit due to promotion could have caused this. The manager is strongly advised to carry out regular audits to ensure he meets his responsibilities as the Registered Manager. The manager was also advised to obtain a copy of the guidelines for the administration of medication from Royal Pharmaceutical Society of Great Britain. Good evidence was seen of PRN protocols. The MAR sheets were completed well and no gaps were seen. MCCH had a policy on bereavement, which would be followed in the case of any death of a resident. The manager did explain that they would always endeavour to keep a resident who had a terminal illness, for as long as it was medically possible. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The home has a robust complaints system and the home’s Adult Protection Policy and procedures protect residents from abuse. EVIDENCE: The home has a new complaints procedure with the new provider and staff are currently digesting all the new procedures. The procedure was seen to be robust and include a whistle blowing policy. The manager was aware of the Protection of Vulnerable Adults register (POVA). The home has adopted Kent and Medway’s procedure on Adult Abuse and all staff are trained in this subject. Discussion with staff confirmed they had a good knowledge of Adult Abuse. The home had received one complaint from a neighbour regarding leaves but this had been dealt with appropriately. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26 Residents benefit from living in a clean, safe, well-maintained environment and have safe access to comfortable indoor and outdoor communal areas. Service users are encouraged to maximise their independence by having access to the range of specialist equipment supplied by the home. EVIDENCE: The Residents enjoyed a comfortable and homely environment, which was well maintained, clean and free from offensive odours. The premises were in keeping with the local community and had a style and ambience that reflected the home’s purpose. The premises were accessible to all of the service users and the garden was accessible by a ramp and was well tended and very pleasant. One service user enjoyed showing the inspectors her plants. Overhead tracking for hoists were seen in the lounge and two of the bedrooms and a selection of slings were seen in the bathroom. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 18 One service user had a specialist chair and the other furnishing were domestic and of a good quality. The manager confirmed the home met with the requirements of the local fire service and environmental health departments. All of the service users had individual bedrooms that were sufficient in size and had sufficient furniture and fittings. All were well personalised to individual tastes and had chosen electrical equipment. The manager stated that he had recently secured a budget of £18,000 to refurbish the bathroom and was waiting for advise from a Occupational Therapist as to the best design to have for the specific needs of the Residents. Discussion also took place of the en-suite in one of the bedrooms that was not used. The home does not have any shared bedrooms. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33 The residents’ benefit from being cared for by staff who have a good understanding of their needs. Some staff shortages mean that the home is slightly understaffed. EVIDENCE: Staff spoken to were able to demonstrate an understanding of the service users needs and of the homes philosophy and values. Good support and interaction between staff and service user was seen throughout the inspection. All staff had detailed job descriptions. With the new organisation, managers were being encouraged to identify gaps in training and produce a training matrix, this will be inspected at the next inspection. Currently the home is slightly understaffed with one full time vacancy, however this had not reduced the amount of activities that are provided. The manager is now more involved with the recruitment and selection process. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 The service users benefit from living in a home where the manager is competent, enthusiastic and very experienced with the care of people with a disability and has a clear vision for the home. EVIDENCE: The manager is already registered with the commission and throughout the inspection demonstrated an in depth knowledge of the residents and of his management responsibilities. However, due to recent promotion, he is not always available within the home. He is reminded that the Commission expects the manager to be in the home for a minimum of twenty hours a week to ensure his responsibilities are fully met. Issue around the medication highlighted this issue. The management approach to the home was also shown to be open, positive and inclusive. 151 Tunbury Avenue H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 3 3 3 1 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x x x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 151 Tunbury Avenue Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x x H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA 20 Regulation 13(2) Timescale for action The registered person shall make Action plan arrangements for the recording, by August handling, safekeeping, safe 21st 2005 administration and disposal of medicines received into the care home. Action plan The registered person shall, having regard to the size of the by August 21st 2005. care home, the statement of purpose and the needs of the service users, ensure that at all times suitably qualified, competant and experienced staff are working at the care home in such numbers as are appropriate for the health and welfare of service users .l Requirement 2. YA 33 18(1)(a) 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. Refer to Standard YA37 Good Practice Recommendations It is recommended that the registered manager works in the home for a minimum of twenty hours per week to ensure all of the responsibilities are met. H56-H06 S64404 151 Tunbury Ave V226032 280605 Stage 4.doc Version 1.30 Page 23 151 Tunbury Avenue Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent. ME16 9NT 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. 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