Inspection on 08/08/05 for 17 Norton Avenue

This inspection was carried out on 8th August 2005.

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 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

17 Norton Avenue 01/08/06

17 Norton Avenue 17/02/06

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 Berwyn Babb Announced 8 August 2005 10:00am 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. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) info@choicesha.co.uk Choices Housing Association Mrs Sheena Morton Care Home 6 6 Category(ies) of Learning Disability registration, with number of places 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14 March 2005 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 6 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 E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a six and a half hour period on 8th August 2005 and had been pre-arranged to be an annual inspection. The inspector toured the whole of the internal and external environment and interacted with all residents, one of whom had recently been admitted to the home and was celebrating her birthday that day. The inspector spoke with all members of staff on duty and did a formal interview with one of them. 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, being a recent admission. What the service does well: What has improved since the last inspection? 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 E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 6 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 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 7 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) 2, 4 The introduction of a new resident to the home enabled more up to date confirmation that proper assessments were taking place prior to people moving into the service. Such up to date information enables a better assurance that care needs will be met. EVIDENCE: The inspector spoke to members of the care staff and examined the care plan of the most recently admitted resident. This established a current multiagency formulation of her currents needs and choices. There was evidence of input from specialist professionals who had particular knowledge in the relation to the conditions that she experiences. There was nothing identified in this assessment that was outside the stated skills and abilities of the staff at 17 Norton Avenue. The records documented that the lady had been able to visit the home prior to her admission, to meet various members of staff and to spend some time interacting with the existing group of residents. It was stated that a major reason for her admission to this home, in preference to the home where she had previously been living, was the single storey nature of its construction, thus reducing the possible danger from falls and other mobility problems. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 8 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, 9 This home continues to operate using person centred planning to produce documentation to reflect the needs and choices of individuals and how these will be met. This includes the use of risk assessments to inform decision making and enable staff to assist residents to meet their changing needs and aspirations. EVIDENCE: The inspector looked at a sample of care plans and concentrated especially on the care plan of the most recently admitted resident. In general the care plans were very detailed about the needs of residents and how these would be met both by the staff in the home and through liaison with outside professionals, clinics, hospitals, doctors surgeries and tertiary health care providers. There will however be a couple of recommendations, in respect of items that the inspector would have hoped to have found in the care plan, namely a risk assessment for the use of an audio monitor at nights for one resident and a review of whether this was the most appropriate means of ensuring her safety. Similarly where there had been a direction initiated in response to the 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 9 demanding behaviour of one resident it will be recommended that there should also be a risk assessment, to establish the need for this. Otherwise there was evidence of thoughtful and informative communication within the daily records of care plans and a demonstration of risk assessments can be positively used to enlarge the scope of a person’s activities. An example of this was a resident who had mobility problems and a level of visual impairment, where her risk assessment had resulted in a care plan for the maintenance of the environment of the home, to ensure that passageways and resident communal areas are kept hazard free. This enabled her to hoover round the home more freely than she would have otherwise been able to do. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15, 17 Activities, occupation and community presence are enabled, as are leisure activities and access to a healthy, balanced and nutritious diet. EVIDENCE: Records and assessments show that none of the current residents of Norton Avenue have or would benefit from attempting employment, though staff facilitate their inclusion in carrying out tasks within the home in line with their assessed abilities. Shopping and entertainment excursions are used to maintain a presence within the community and one residents left the home during the inspection for a celebratory meal out with her care worker. She had already been visited by members of her family bringing presents for her birthday that day. Most of the residents were excited by the talk of the annual holiday that staff were facilitating, with the majority opinion being in favour of a return to 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 11 Blackpool. One resident robustly expressed the view that the caravan owned by Choices Housing Association, did not comfortably meet everybody’s needs and asked not to be taken there again. It was observed that much of staff time was spent on a one to one basis with residents and key workers enabled them to access the community through the provision of either escort or transport or both. The inspector learned anecdotally that this included use of taxis, public transport and company vehicles. Not everybody in the home had close family contacts and staff comments and care records demonstrated that an advocate had been sought for residents where a specific need arose. There was also evidence, as there is in all Choice’s Homes of the shared history of many residents establishing quasi family links between them and there is a well established history of residents visiting each other in different homes both informally and for such things as coffee mornings and BBQ’s and other hospitable events. The inspector was able to observe the preparation of the shared mid-day meal, for which one resident and her key worker had made a shopping exhibition during the morning and this was nutritious, adequate and in line with dietary considerations that were confirmed in residents care plans. As stated earlier one resident was enjoying lunchtime out with her key worker to celebrate her birthday that day. Examination of the food served record and rotating menu programme demonstrated variety and a willingness to experiment, the response to which have been variable. Some new dishes had been added as a result of this and some were definitely rejected. The inspector was able to observe residents receiving encouragement and assistance in a sensitive manner that ensure that they have enough to eat, without infringing upon their dignity. Kitchen area when examined was found to be clean and tidy and well ordered with sufficient food stocks to weather any sudden civil emergency and of branded, good quality rather than budget basics and also demonstrating a good variety. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 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 standard(s) 18, 20 The provision of personal care support by staff maximises residents privacy, dignity, independence and control over their lives. EVIDENCE: Having established a base line of people’s needs through reading care plans, the inspector was able to observe in relation to various individuals, sensitivity and dignity in prompting and assisting them to carry out personal care tasks. Staff remained unflustered in the face of inattention caused by excitement or the desire for instant gratification of other needs and gently persisted in encouraging such things as regular toileting especially before trips out into the community. All staff on duty were female, but it is recorded in the care plan of the male resident that he has no objection to receiving care from somebody other than a male. The home is not equipped with a vast amount of disability equipment but hand rails in toilets and the use of showering facilities are in themselves more enabling for people with mobility issues. As has been previously detailed, the very nature of the single story environment has been used to advantage to meet the assessed and changing needs of residents accommodated by Choices Housing Association. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 13 None of the current residents of 17 Norton Avenue are assessed as having the capacity to administer their own medication. This is done on their behalf by members of staff and an examination of the medication administration record was made without prompting any concerns. A review of procedures and of arrangements for storage, ordering and disposal of (unwanted) medication was carried out and this similarly demonstrated that policies and procedures were being followed in accordance with the laid down standards. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 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 standard(s) 23 Staff are aware of policies and procedures and there is a culture within the home of robust advocacy to limit any possibility of abuse to residents. EVIDENCE: The inspector observed in care plans steps being taken to protect residents and to ensure that their assessed needs were promptly and adequately met and in discussion with staff was able to review the policy, procedures and attitudes regarding the protection of this extremely vulnerable adults. Additionally, he undertook a formal interview with one of the care assistants and confirmed that her appreciation of what constituted abuse was not confined to physical assault. She spoke knowledgeably about practices that would be considered to be neglectful and correctly identified not only the procedures to be followed should abuse be suspected but also the inclusive nature of just who could abuse a vulnerable adult. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 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 standard(s) 24, 25, 30 A small number of aspects of the environment of this home do not promote the welfare and comfort of residents. EVIDENCE: During the internal inspection of the home, it was noted that whilst the radiator in the communal dining area was appropriately guarded, those in other areas especially in residents bedrooms, were not protected in the same way. This has to be of concern especially for residents where care plans identified a history of falls and mobility problems and custom and practice (without evidence of risk assessment) has led to the use of an audible monitor at nights to give staff early warning when one resident leaves her bed because of the dangers this poses for her. The inspector was similarly concerned over the state of carpets in residents bedrooms. Whilst not currently constituting a trip hazard, they have reached the age when cleaning no longer has the desired affect and from where they will quickly deteriorate to the point of creating a mobility hazard. It will be a requirement of this report that they are replaced and there will be another 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 16 requirement that all radiators and pipe work are either guarded or of low temperature surface manufacture. The home was clean and hygienic throughout with appropriate separate laundry facilities that from the evidence of staff spoken to enabled the proper implementation of infection control standards and policies. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35 Residents were being cared for by staff who mostly demonstrated the experience, training and skills to meet residents needs and promote their choices and welfare. EVIDENCE: Discussion with staff and observation of their interaction with residents, confirmed that they had a knowledge of the needs and assessed conditions represented at 17 Norton Avenue and further that they were able to use this knowledge to work skilfully to diffuse conflict and behavioural situations before they had time to escalate. In a formal staff interview, the inspector was satisfied that the policies and procedures followed by Choices Housing Association when recruiting new staff meet both the requirements for equal opportunities for staff and protect residents by validating references and police checks and by a robust period of induction. One member of staff did bring to the attention of the inspector that she would welcome more in-depth training on individual aspects of learning disability such as autism or Asberger’s syndrome and this will be reflected in a recommendation of this report. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 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 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) 39, 42 Steps were being taken to maximise and record the views of residents in relation to the running of the home. Documents and observation confirmed similar steps being taken to provide them with a safe and wholesome environment. EVIDENCE: The inspector is aware that Choices Housing Association are so concerned about ensuring residents have a voice in auditing the quality of care in their homes, that they have initiated a scheme where residents join staff in quality assurance. Not every resident has an equal capacity to undertake this task, but the more able act as advocates on behalf of their peers. The scrutiny of documentary records and observations made during the day, taken together with the policies and procedures produced by Choices Housing, suggest that every step is taken to ensure the health, safety and welfare of residents at 17 Norton Avenue. 17 Norton Avenue E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 19 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 4 x 4 x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 4 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 4 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 17 Norton Avenue Score 4 x 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 20 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 24 Regulation 13.4 Requirement Pipework and radiators must be guarded or have low temperature surfaces. Carpets in residents bedrooms must be replaced. Timescale for action To be implement ed by 08/10/05 By 08/10/05 2. 24 13.4 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 6 6 Good Practice Recommendations Wherever a care plan has been implemented, this must be justified by an available risk assessment. Thee use of an audio moniotor for a resident must be reviewed, and if further consideration still supports this as being the most appropriate means of meeting her needs, a risk assessment should confirm this, and the signature of the resident, or her advocate, be obtained on the care plan. Staff must be enabled to fulfill the training needs that they have identified. The registered person is recommended to apply for a variation to reflect the aging of the current residents, and to ensure bthat she does not continue to operate without the necessary registered categories. E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 21 3. 4. 35 3 17 Norton Avenue Commission for Social Care Inspection Stafford - 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 E51 E09 s8216 17 Norton Avenue 080805 v245399 Stage 4.doc Version 1.40 Page 22 - 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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