Inspection on 17/02/06 for 17 Norton Avenue

This inspection was carried out on 17th February 2006.

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

The inspector found 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

17 Norton Avenue 01/08/06

17 Norton Avenue 08/08/05

17 Norton Avenue 14/03/05

17 Norton Avenue 09/08/04

17 Norton Avenue 26/01/04

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

CARE HOME ADULTS 18-65 17 Norton Avenue Burslem Stoke-on-trent Staffordshire ST6 7ER Lead Inspector Mr Berwyn Babb Unannounced Inspection 17th February 2006 14:45 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 17 Norton Avenue Address Burslem Stoke-on-trent Staffordshire ST6 7ER 01782 819870 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) Choices Housing Association Limited Mrs Sheena Morton Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6), Physical disability (6), of places Physical disability over 65 years of age (6) 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents with either Learning Disability (LD or LD(E)) category may also have a Physical Disability (PD or PD(E) 8th August 2005 Date of last inspection Brief Description of the Service: Norton Avenue is a purpose built, single storey home situated in its own grounds in Norton, a residential area of Stoke-on-Trent. It is one of a group of homes managed by the Choices Housing Association, which is a wellestablished provider of care for people with learning disabilities in North Staffordshire. Norton Avenue is registered to provide care for six adults with a learning disability. It also has a variation to accommodate six persons with a physical disability. The current resident group of five females and one male range in age from 48 to 82 years, although most are over 60 years old. All of the residents have previously lived in long stay hospital settings. Most came to this home when it first opened approximately 12 years ago. The home is conveniently situated to access local transport routes and a range of amenities. A disadvantage with its location is its position on a very steep road, as several of the residents now require the use of a wheelchair to go out. The home has access to its own transport provided through the company. There have been no major structural changes since the last inspection. This report follows the younger adults format, as it was the opinion of this inspector that those standards were more pertinent to the residents of this home, as their primary needs remain those associated with Learning Disability, and not old age. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the previous inspection of 08/08/05 seventeen of the twenty-one core standards were assessed, together with four other [non core] standards. Two requirements were made, though unfortunately neither of these had been completed at the time of this inspection. The inspector toured the whole of the internal environment and interacted with all residents. He spoke to all members of staff on duty. He was grateful for the help and assistance freely given. He also inspected a sample of resident’s care plans, chosen in response to trigger indications observed at the time. For instance, having an intrusive piece of monitoring equipment, and being the least mobile resident. The home was providing a placement for a nursing student who on the afternoon of this inspection was assisting residents to enjoy their daily quiet time. What the service does well: What has improved since the last inspection? There have been no major changes in the home since the last inspection. Two further radiators have received covers to protect residents from potential harm. A new microwave oven and a new dishwasher have been installed in the kitchen. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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): 3 Core standards 2 and 4 were covered in the report of the previous inspection of 8th August 2005, and from this inspection it was deemed that a resident had known of the ability of the home to meet her changing needs. EVIDENCE: The inspector spent a considerable amount of time with a lady who had transferred from another home being run by the provider Choices Housing Limited. She told him that she had wanted to come to 17 Norton Avenue, not only because she had known most of the other residents from the long stay hospital, but because the purpose built single storey accommodation would be more suitable to her increasing mobility needs. She was also agreeable to the use of an audio monitor in her bedroom, as she felt reassured by staff being able to tell if she was getting out of bed half or fully asleep. She had experienced several falls in this state, and was afraid of doing herself further damage. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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): 7 Adequate and appropriate procedures were in place to maximise the impact of decisions that residents were able to make about their lives. EVIDENCE: The inspector had a long conversation with one resident who had made robust input into the decision to move to 17 Norton Avenue, and in the matter of the audio monitor, reference to her care plan showed that it had only been implemented with her agreement, and was the least restrictive way of meeting her best interests, consistent with the aims and objectives of the home to maximise independence whilst ensuring the health, safety and welfare of each resident. The care plan also demonstrated regular attention and review to the choices of the individual, with sections to record the likes and dislikes of the resident, and a check list to review their priority of both assessed and changing needs, and their individual wishes. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15,16,17 Residents were assisted in conducting appropriate relationships and maintaining family and friends contacts, enjoyed a daily routine that respected their dignity, rights, and responsibility, and were offered a healthy diet that included appropriate amounts of their favourite foods. EVIDENCE: The inspector spoke to the family of one resident at some length, and they confirmed that they were welcome in the home at all reasonable times, and were incorporated as much as possible into the routines of the residents of the home. Staff enabled them to see their cousin in relative privacy without having to spend the whole of their visits in her private accommodation, and this included positioning her in a special orthopaedic chair, that had been assessed to meet her physical needs. Conversation with another resident, which was confirmed by reference to her care plan, identified that she was able to maintain regular contact with previous friends and co-residents, members of her family, and to make 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 11 fortnightly visits to a particular personal friend with whom she had been associated for many years. References in the care plans were confirmed by residents in relation to them undertaking (assistance) minor domestic tasks around the home, and routines were seen to be geared to maximising their individual choice and freedom. One care plan contained very detailed instructions to staff to ensure the floor area was always free from discarded items, so that those residents with impaired mobility and vision, would be less at risk from falls. Both residents and relatives assured the inspector that attention to diet was enthusiastically maintained, and that, within the boundaries of good sense, residents enjoyed their favourite dishes as part of a balance, nutritional programme. Weight charts and body mass index measures were seen in the care plans, together with measures for ensuring attention to such necessities as diabetic control, cholesterol levels, and the avoidance of any dislikes and allergic foods. The kitchen continued to receive attention to maintain a proper standard, and since the previous inspection the microwave oven had been replaced with a new one. The availability of refreshment throughout the waking day was identified in one care plan, where it was recorded that the particular resident liked to have a milky drink and a piece of toast at around 8.30pm each evening. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The home was delivering care to both the physical and emotional healthcare needs of the resident. EVIDENCE: The inspector examined a sample of care plans chosen at random for case tracking, and from these he was able to conclude that a primary focus of the home was to promote the health needs of the residents. Relevant examples of how this was demonstrated was use of a strategy known as the OK health check list, risk assessments for falling, provision of special glasses to suit both the visual and behavioural needs of the resident, referral to the orthotics department for suitable footwear, [this last coupled with regular visits to the chiropodist], and the provision of such aids and equipment as slings, continence pads, and wheelchairs. Regular and one off contacts were recorded with hospital consultants and various clinics, GP’s and outpatient appointments, district and community nurses, and professionals in the provision of occupational therapy, speech therapy, and the specific needs of those with a learning disability. Each of the care plans sampled contained material for both training and daily use from the 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 13 British Institute of Learning Disability, on whose standards Choices Housing Association Ltd base all their policies and practices. As well as regular visits to and by the dentist, a care programme was observed to have been designed to enhance the process of maintaining oral hygiene for a particular resident. There was also evidence that residents were receiving regular checks for their feet, eyes, and hearing. Programmes were detailed various emotional and behavioural contingencies, and input and advice had been recorded from the community behavioural team. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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 Key standard 23 was reported upon after the previous inspection of the 8th August 2005 and from this inspection it was deemed that the home made maximum effort to establish and respond to any concerns that residents may have. EVIDENCE: In those care plan examined, there was extensive use of pictorial symbols, especially in the complaints procedure, though staff did tell the inspector that in most instances, they had to reinforce these verbally. They also considered that detection of any concern that some residents may have depended as much on their knowledge of that person and the reading of their body language, as it would do upon a straight verbal referral. The provider is acutely aware of the vulnerability of their residents, and has established a forum for resident advocacy, where some of the more able residents housed by the organisation used their time, skills, and empathy, to enable those residents who are less able to communicate. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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): 24,28,29 Both key standards were reported upon after the inspection of 8th August 2005, and unfortunately the requirements made at that time regarding radiator covers and frayed carpets have not yet been addressed. However from this inspection it was seen that other areas in the home were well maintained, and that their specialist equipment was properly assessed and provided by relevant care professionals. There was sufficient communal space and carers were facilitating an appropriate range of activities. EVIDENCE: The requirements of the previous report, namely, that radiators and pipe work must be guarded, or have low temperature surfaces, and that carpets in resident’s bedrooms (where identified at the time of the inspection), must be replaced, had not been acted upon. Any further non compliance will now lead to enforcement action being initiated. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 16 Other than these two regrettable items, the standard of construction, design, and maintenance of this home continued to make it well fit for its purpose. It is a single storey, modern style, dwelling, that is located in a residential area, and not stigmatised by any sign or other means that it is in fact a residential home. The only drawback of its location, which has been reported upon previously, is the severity of the gradient on Norton Avenue, something that makes taking residents out other than in vehicular transport, is extremely taxing on staff. As indicated elsewhere in this report, the provision of both a dedicated lounge, and a lounge/diner (with kitchen off), enables residents to have time out either on their own or with their visitors, as well as providing opportunities for more than one activity to take place. It also allows for residents not wishing to join in the commotion of the larger room, to have quieter space with or without the benefit of the television or music centre. Among the specialist equipment being provided for residents, as well as wheelchairs and wall mounted hand rails along the corridors of the home, there were steady rails to the toilets, electrically operated orthopaedic chairs, slide sheets, ramps, footwear, slings, hoists, and a Malibu bath chair. Checking through the care plans revealed, that the involvement of relevant professionals for both assessment, and provision, of these aids/adaptations had been recorded. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35 Residents were being cared for by staff who were supported by a training programme that enabled them to obtain the relevant qualifications to meet the assessed needs of the individual. EVIDENCE: The inspector spoke with members of staff on duty during the afternoon, and they told him of the various courses, and one off training events, that they were provided with by their employers, the inspector was also able to examine the log of future training booked for staff at this home throughout 2006, and can report that mandatory training has been arranged as follows: Moving and Handling training will take place on 26th June, 17th July, 13th October. Abuse training will take place on 22nd May First aid training took place on 10th February and further events are arranged for 18th July and 3rd November. Food and hygiene training has been arranged for 25th July and one session has already been completed on 31st January. Fire safety training, one session took place on 13th January, and further sessions had been arranged for 8th May and 7th August. The schedule also included windows for new starters and current staff to undertake 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 18 individual training as indicated, through their supervision and annual appraisals. What all this meant in practice was, that the inspector observed members of care staff responding to the assessed and ongoing needs of residents in accessible and approachable ways that by no means compromised the dignity of those people they were assisting in personal care tasks. The attitude of staff on duty during the inspection was inclusive to the residents rather than being exclusive of them, in as much as all conversation was through them and with them, rather than marginalising them by conversing behind their back or above their heads. The inspector was also able to observe skilful use of de-escalation techniques where a member of staff recognised the onset of a particular behaviour that would be likely to broach the residents dignity, and instruction and advice about these techniques was found recorded in the appropriate care plans. In discussion with staff he learned of techniques being used to aid communication, trigger mechanisms that were known to cause outbursts, how patterns of body language had come to be understood and recorded, and the delicate balance required to ensure that the needs and wishes of one resident did not impose adversely on any other resident. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Both key standards for this section were previously reported upon after the inspection of 8th August 2005. Documents and observation confirmed that steps were being taken to provide residents with a safe and wholesome environment. EVIDENCE: The inspector checked the fire safety and RA records , and is able to report that these recorded satisfactory compliance with the advice of the local fire service. In particular, fire alarms had been checked each week, emergency lighting had been checked each month, equipment had been checked at the relevant intervals, training of staff had taken place four times each year, and both staff and residents had taken part in simulated emergency evacuations. Given the level of dependence of some of the residents in the home, it was encouraging to note the individual risk assessments of their care plans, covering their known and anticipated personal response should a fire be discovered. 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 4 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 3 29 3 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 4 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 4 X X X X X X X 3 X 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 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. 2. Standard YA24 YA24 Regulation 13.4 13.4 Requirement Pipework and radiators must be guarded or have low temperature surfaces. Carpets in residents bedrooms must be replaced. Timescale for action 17/02/06 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 17 Norton Avenue DS0000008216.V283290.R01.S.doc Version 5.1 Page 23 - 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. 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