Inspection on 05/07/05 for 18 Franklin Avenue

This inspection was carried out on 5th July 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

18 Franklin Avenue 08/02/06

18 Franklin Avenue 22/06/04

18 Franklin Avenue 18/03/04

18 Franklin Avenue 07/03/03

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 18 Franklin Avenue 18 Franklin Avenue Barton le Clay Bedfordshire MK45 4LN Lead Inspector Ansuya Chudasama Announced 5 July 2005 th 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. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 18 Franklin Avenue Address 18 Franklin Avenue Barton le Clay Bedfordshire MK45 4LN 01582 883465 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) Aldwyck Housing Association Mrs N Parrott CRH Care Home 6 (6) (6) (6) Category(ies) of LD registration, with number LD(E) of places PD 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9.12.04 Brief Description of the Service: 18 Franklin Avenue is a purpose built bungalow, which was registered in 1996 to provide residential care to six adults with learning disabilities. The home currently provides care for adults with profound learning disabilities. Aldwyck Housing association through contractual arrangements with the Bedfordshire Joint Commissioning Agency manages the home. The bungalow has six single bedrooms that were built, to a wheelchair accessible specification. There is an adapted spa bath and additional level access shower close to the bedrooms. Communal space includes a large kitchen/dinner and lounge with views over an attractive patio and garden. The home also has a sensory room. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was undertaken at 09.30, and it took place over 7 hours. The registered manager was off sick and the deputy manager Claire Marron had been acting up as the manager of the home since January 2005. The inspector was informed that the manager of the home was due to return to work on the 12th July 2005. Ms Marron was present at the inspection. The inspection was comprised of a tour of the communal areas, two service users’ bedrooms, talking to staff and link workers of service users, and talking to service users. Two service users’ case records and other documents were inspected in detail. There were six service users living at the home at the time of the inspection. What the service does well: What has improved since the last inspection? 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 6 The staffing situation at the home had improved. Service users activities had increased and these were being reviewed regularly. The home had introduced a detailed handover sheet and new care planning documents which were very good. New night observation charts seen were good. Staff training had also increased. 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. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 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 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 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) 1,2,3,4,5,6 The homes statement of purpose and service users’ guide provided prospective service users and their family’s information of the services the home provides enabling an informed decision about admission to the home. EVIDENCE: The above documents contained information about the services the home provided for the service users. The Acting manager stated that the service users guide was being produced in a format using pictures and symbols. Records showed that the home undertook detailed risk assessments of service users prior to their admission. Service users and their families were able to visit the home and have overnight stays to find out if they wanted to stay at the home. Service users had contracts with the home. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 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 standard(s) 6,7,8,9,10 There was clear and consistent care planning systems in place to provide the staff with the information they needed to meet the needs of the service users to a high standard EVIDENCE: The acting manager had recently introduced a new system of care planning and this was very good. This consisted of having a separate file on personal care needs, health care needs, activities, risk assessments and finances. All the information required in the care plans as stated in the standard was recorded. The staff also found this system very helpful and easy to understand. It was stated that they got involved with service users care plans. The care plans were reviewed on a six monthly basis or sooner. The service users and their families were involved with care plans and annual reviews. The home had also introduced an excellent new service users daily recording form. This contained information about what the person had eaten, the medication given, and any activities undertaken. Three entries were recorded by staff to state what the service user had done on each shift and this was signed by them. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 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) 11,12,13,14,15,16,17 Service users have opportunities for personal development to enrich their social and educational opportunities. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices EVIDENCE: The staff were observed giving service users breakfast by talking to them and helping in a sensitive manner. Observation also showed that all the service users enjoyed having physical contact with staff and observation showed that this was provided in a professional and appropriate manner. The expression on service users faces also showed that they liked the staff and they were very happy at the home. The staff spoken to stated that they understood the needs of service users by getting to know the person. They stated that they communicated with service users who were not able to communicate verbally by understanding their body language, the sounds they made, and through their facial expressions. Several examples were given by staff to explain how 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 11 they knew when service users were happy or unhappy. An activity sheet was seen for service users that were case tracked. The staff spoken to stated that they discussed the activities that service users undertook to find out if they enjoyed them and the suitability of the environment was also noted. Due to staff shortage, the activities in the home had lapsed. However this had now been resolved since the home was better staffed. The staff spoken to were aware of the food and activities the service users enjoyed. The home had an open door policy and evidence showed that service users’ families visited the home and attended their reviews. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 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) 18,19,20,21 The knowledge of staff, safe systems for administering medication and detailed care planning meant that the health needs of service users are met. EVIDENCE: Service users personal and health care needs were being met by the home. The information in the care planning documents clearly stated how these needs were being met. The staff spoken to also gave detailed examples of how they cared for the service users. Appointments with health professionals were recorded well. All staff who gave out medication had received the accredited training and records were well maintained. Information on service users burial arrangements was recorded. Staff had received training on how to care for service users who were very ill. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 13 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 staff have good knowledge and understanding of adult protection issues, which protect service users from abuse EVIDENCE: The keyworkers of service users’ files inspected stated that understood the needs of service users well. They stated that they communicated with service users who were not able to communicate verbally by understanding their body language and their facial expressions. It was also stated that they understood the sounds and noises made by the service users. They had also obtained detailed information from families to understand their needs. However if they were not sure about any thing, they usually asked them for their advice. Several examples were given by staff to explain how they knew when service users were happy and unhappy. The staff also discussed this in their meetings to ensure that they were meeting the needs of the service users. The two staff spoken to had read information on adult protection and had guidelines on what to do if they suspected abuse. One staff had been on a training course on POVA and another staff was due to go in August 2005. The home had a complaints policy and this was being reviewed. No complaints had been made to the home since the last inspection. It was stated that families of service users knew how to complain if they were not happy with the care provided by the home. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 14 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) 24,25,26,27,28,29,30 The premises were well maintained so as to allow all those living at the home to enjoy a homely and comfortable environment that was safe, clean, and hygienic. EVIDENCE: The home was purpose built to accommodate wheelchair users. The homes premises were clean, safe and well maintained. The furnishings and fittings were of a good quality and had a homely appearance. All service users had single rooms. The rooms were all individualised, and some had ceiling hoist and other equipment to meet the needs of the service user. The home encouraged service users to bring in their personal items to make their rooms more homely. The home had a walking shower, two shower chairs and sufficient numbers of toilets. The bathroom had music and a bubble bath matt. A hoist was also available in the bathroom. The bath was also raised to meet the needs of staff and service users. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 15 The home exceeded the space requirement of the National Minimum Standard. The home had a spacious kitchen/dinning room with access to the garden. A large lounge and a quiet/sensory room were also available. All the rooms were pleasantly decorated and well maintained. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 The home provided very good training so that the people living at the home had their needs met by competent and suitable staff. EVIDENCE: A new member of staff spoken to stated that “it was fantastic here” and he was undertaking the homes induction programme. He was also booked to go on a number of training courses. Other staff that were spoken to stated that the training received by the organisation was very good and it was linked to meeting the needs of the service users in the home. This was confirmed by inspecting the staff training programme. The staff spoken to on duty were very experienced, and one of them stated that she had completed NVQ level 3 training. She also taught this course to students at college. The staff stated that supervision had lapsed, however since January 2005 this was happening more regularly. This was due to staff being on maternity leave and the manager being off sick. The staff had monthly meetings and it was stated that they were encouraged by the manager to bring up ideas and any concerns identified. The vacancy hours were being worked by agency staff who were stated to be good. All the staff spoken to stated that they worked well as a team with “good team sprit”. The home had recently recruited two fulltime staff. The files seen had all the information required in the standard. However one staff spoken to had expressed concerns about the recruitment of staff. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 17 She wanted to find out why some jobs were not advertised externally and others were. The inspector discussed this with the services manager, Marian McEwen who explained the recruitment procedure of the organisation and showed that they were operating their recruitment procedures. The service manager was going to discuss this issue with the staff member concerned. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 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) 37,38,42 The home has an experienced and committed acting up manager who ensures strong leadership, and safe working practices so that service users health, welfare and safety are safeguarded EVIDENCE: The staff spoken to stated that the acting up manager had worked very hard to get things done. They also stated that she had brought new ideas and enthusiasm to the home. It was stated that in the past staff discussed new ideas however this could not be implemented due to being short staffed. However the acting manager had worked hard to get the home fully staffed. The acting manager had also started getting staff on training courses. The staff stated that the manager involved them more and they knew that they were going forward. It was also stated that the changes taking place in the home were good and staff were trying out new ideas. All the staff had received the training on health and safety, and risk assessments were also available for the environment. The appropriate checks on health and safety of the home were being carried when they were due. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 19 The staff files seen had all the relevant information required by the standard. 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score x x 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 4 3 4 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 18 Franklin Avenue Score x x x x Standard No 37 38 39 40 41 42 43 Score 4 3 x x x 3 x I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 21 NO 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations 18 Franklin Avenue I51 S14902 18 Franklin Avenue V231338 050705 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Clifton House Goldington Road Bedford MK40 3NF 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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