Inspection on 18/12/07 for 2 Central Avenue

This inspection was carried out on 18th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2 Central Avenue 02/12/08

2 Central Avenue 04/07/07

2 Central Avenue 01/08/06

2 Central Avenue 05/12/05

2 Central Avenue 20/07/05

2 Central Avenue 01/02/05

2 Central Avenue 20/07/04

2 Central Avenue 12/01/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 2 Central Avenue 2 Central Avenue Billericay Essex CM12 0QZ Lead Inspector Mrs Bernadette Little Unannounced Inspection 18th December 2007 09:00 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 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 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 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. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 2 Central Avenue Address 2 Central Avenue Billericay Essex CM12 0QZ 01277 655394 01277 655394 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) Estuary Housing Association Limited Mr Russell Neil Groves Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2007 Brief Description of the Service: Central Avenue is a Care Home for four service users with Learning Disabilities. It is situated between Billericay and Stock. The home is registered for service users up to and over 65 years of age. The premises comprise of a bungalow with four single bedrooms, a bathroom, a lounge, kitchen/dining room and a small conservatory area with access to a large garden to the rear of the premises. There is also a garage for the homes minibus. The laundry area is situated in a room behind the garage. The premises are in keeping with the local community. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with information on the home. The weekly fee of £1719.53 and residents’ contributions range from £63.90 - £98.60 was advised at the site visit of July 2007. Additional charges/costs are incurred by residents relating to chiropody, purchase of personal toiletries, bedroom furniture. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key unannounced inspection of 2 Central Avenue this year. The site visit took place on over a five and a half hour period. A tour of the building took place, random records and policies were inspected and time was spent talking with the residents and staff, observing care practice and seeking their views. The manager was not available at the site visit and access to information and records was limited in some areas. The staff on duty at the time of the site visit assisted but were limited by a lack of access to, and/or knowledge of the records and information required. Contact details for relatives and professionals involved with the residents was requested from the manager prior to the site visit but this was not provided. Written surveys were also sent to the home with a request that these be distributed. The manager subsequently advised that he thought these had been sent to relatives. No responses were received. Contact was sought by telephone with some relatives and professionals to seek their views on the home. Those responses obtained are reflected in this report. Prior to the previous inspection, a staff member had completed an Annual Quality Assurance Assessment (AQAA) and returned it to the commission. Information from this document was taken in account and is included in this report. Following the key inspection of July 2007, the registered provider was required to send the commission an improvement plan that clearly detailed how they were to meet the requirements identified in that report. This was received but did not provide clear information or acknowledge specifically that requirements were not being met. Further clarification was requested but to date has not been received. Some of the issues remain outstanding at this inspection. The assistance of all those who participated in this inspection process is appreciated. What the service does well: 2 Central Avenue gives residents a homely and comfortable place to live, where they each have their own bedroom, giving them some private space. Support is offered by staff who talk with residents in a friendly way and build relationships with them. A resident spoke of a staff member and said “she is nice”. A professional said of the staff “they are lovely, friendly, kind people”. Residents’ healthcare needs are well supported in their everyday life for example in having a healthy eating plan. Residents spoken with said they liked the food at Central Avenue. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 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 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment system helps to ensure that the team at the home can meet the needs of the residents they admit and the information available would allow people to make an informed decision about the home EVIDENCE: The statement of purpose and service user guide were displayed in the office. The service user guide has information in large print and supported by pictures to make it easier for residents to understand. As was noted at the last inspection, some of the information in the service user guide is out of date, for example how to contact the Commission for Social Care Inspection, or the cost of living at 2 Central Avenue. No new people have come to live at 2 Central Avenue since the last inspection. Estuary have clear systems in place to find out the persons needs before they come to live there, to make sure that 2 Central Avenue is the right place for them and that the staff team can meet their needs properly. Each resident has information about living at the home, for example what money the person has to pay and what services they get for it and this is called ‘terms and conditions’. A copy of this was seen in each of the resident’s bedrooms. It too was written in large print and had pictures to help people to 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 9 understand it. There was a letter on each persons file to say how much they each had to contribute and when this changed. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst residents are supported to live independently, within a safe framework, shortfalls in residents’ involvement in their care planning could limit positive outcomes at times. EVIDENCE: Each resident had a care folder that had information for staff about the things the person could do and the things that they needed support with. The information on how to support residents in everyday practice had clear detail for staff to follow so that residents got consistent care in the way that they needed and preferred. There were lots of assessments that looked at any risks there might be, with clear guidelines on how to manage these to safeguard both residents and staff. There was not much to show that a resident had been involved in these and only one was signed by the person. These records, along with discussion with the resident at the site visit, showed that a resident was supported to take 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 11 appropriate risks for example managing their own finance and going out unaccompanied. The risk assessments show that the resident’s dignity and privacy was thought about and respected. There was a record to show that, where a resident could not have a particular choice because this was decided as being best for them, it had been talked about with the person and they had agreed to it. The care plan risk assessments looked at said they were to be reviewed in October 2007, but there was no record to show that this had been done to make sure they were still right for that person. Most of the residents also had another care plan that was written in a person centred way. This had photographs and symbols to help explain them and a signed record that staff had read and explained it to the resident. Care notes were written at the end of each shift by the staff to say how the resident had been during that time, any support they had been given, and how they spent their time. These had good information to help monitor the persons well-being and if the plan of care was working well for them. The agency staff on duty explained that they read the care plans when they first come to work at the home to help them get to know about the residents and what they need. They read the diary and the care notes from the previous shift at the start of their shift so they know about any new information for that resident. What does aqaa say ? 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities programme is limited in areas, which means that not all residents have their social care needs met. Residents are well supported to maintain relationships and meals provided to residents are satisfactory. EVIDENCE: Residents’ opportunities for stimulating and meaningful daily activity, leisure and community involvement was reviewed, and this has been an identified ongoing area for the home to develop and improve on. Care plans and care notes show that residents are involved in everyday tasks in the home that support maintenance of dignity and independence. A resident’s assessment documents show that they like swimming, bowling and going to the cinema. A record is maintained to monitor residents’ activity opportunities. A sample of a recent seven-week period showed that the person had not attended any of these activities during that time. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 13 The activity monitoring sheets showed that during the seven-week period all service uses had gone out together three times for a meal. The other activities recorded for various residents were going shopping, going to the chip shop, going to Estuary’s head office for a ride to drop off records, choosing a rabbit hutch at the pet shop, cleaning and vacuuming the home’s van and one person watched a football match. The staff on duty at the time of the site visit were both agency staff and the duty rota for that week shows that on five days, two agency staff were on duty on either the early or late shift. The agency staff spoken with confirmed that they were not drivers. This additionally restricts residents’ opportunities to access the community or make active choices to go out. The AQQA identified their plan as including more opportunities for residents’ personal development, including work and college opportunities but there was no evidence that these had happened. The last inspection report identifies that work already undertaken to convert the garage into a social/activity area for residents and other local service users needed to be redone, there was little evidence that this had occurred. Discussion with professionals involved with the home also identified the lack of activities as an issue. One commented in many respects this is a very good home but there is a lack of things to do for residents during the day, they could be doing much, much more. Discussion with residents and review of care notes confirmed that the staff team support a resident to remain in contact with their family through telephone calls and visits. Residents spoken with confirmed that they liked the meals. A menu plan was displayed in the kitchen and residents asked staff what was for lunch or for dinner. Staff also offered residents choices for example which one would you like, take the one you want. A record of food served was maintained and ample food stocks were observed. Staff were aware of residents individual needs in relation to healthy eating plans or specific behaviour issues relating to food and drink. Residents who are able, were able to offer to make a choice of drinks for themselves and others. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Residents are happy with the personal support they receive and they had positive opportunities to access healthcare provision. EVIDENCE: Residents have named key workers from the staff group but receive personal support from all the staff. Staff advised that all service users are mobile and participate in their personal care with varying levels of prompts, supervision or support. Staff on duty knew about how much support residents needed for their personal care, and also the things that they could do for themselves, as identified in their care plans. They also knew about peoples different ways of behaving and how best to help them with this. Residents knew the name of the staff that were supporting them at the time of the site visit and they talked and joked with staff freely. Staff in turn spoke to residents by name, listened to them and encouraged them to make choices. Residents spoken with said they were satisfied with the support that staff provided them with. Residents’ health care needs were clearly identified within their health care support plans. These showed optical and dental checkups, weight monitoring 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 15 where this was part of the person’s care needs and routine appointments with the GP or community nurse. Records showed the date of the intervention, the reason for it, outcome outcomes and any follow-up required or planned. The staff on duty were aware of a resident’s medical appointment on the day of the inspection and provided appropriate support to the person for this. They were also monitoring a resident they felt had not eaten as well as usual and seemed to be tired, recording this in the persons notes to pass onto the next shift so that they could consistently monitor the resident’s health and well-being. Professional stakeholders spoken with confirmed that staff a very good at supporting residents to access health care services. Views varied on the staffs success at communicating on healthcare issues. The medication systems were reviewed and records were found to be generally well maintained. It was noted positively that there were no omissions on the medication administration records (MAR), and an up-to-date list of the names and sample signatures of staff that give out medication was available, both are noted as improvement since the last inspection. As noted at the last inspection however, the start date of each medication is not clearly identified on the MAR, making it difficult to audit the medications remaining against the records to ensure that they tally accurately. Both of the agency staff on duty had records to show that they have received training in medication administration with recent updates. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service have access to a clear complaints process. Whilst arrangements are in place to adequately safeguard residents and promote their protection from abuse, shortfalls in staff knowledge and procedures relating to finance, could adversely affect outcomes for them. EVIDENCE: The complaints procedure was readily available in a user friendly format in the home and information about making a complaint is also in the service user guide. The Commission has not received any complaints regarding 2 Central Avenue. The agency staff on duty stated that they were unaware whether or not the manager had not received any complaints about the home. The files sampled for permanent staff showed that they had had recent updated training in protecting vulnerable people and that they had received training in managing behaviour that challenges to help them support residents positively. The agency staff spoken with had evidence of updated training in protection of vulnerable people. They advised that they would inform the permanent staff, or the manager, or their employing agency or the commission if they had any concerns regarding the way residents were treated at the home, but showed no awareness of reporting to the local authority. The staff spoken with advised 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 17 that they had not seen the whistleblowing procedure, and this is not included in their first-day induction record. Prior to the last key inspection of Central Avenue, the manager had not reported an event under the safeguarding procedures until the registered provider was instructed to do so by the Commission. This was subsequently undertaken and continues to be investigated. At this site visit, records noted that another event has been advised to a social worker relating to safeguarding procedures, which is an improvement from the last inspection, but remains a concern as it relates to the safe management of a resident’s money. The issue is being investigated currently. The manager had not reported this to the commission as required. It has been confirmed with the safeguarding team that it not currently considered a safeguarding issue, and procedures had subsequently been put in place to protect the resident. The staff were unclear as to what action to take when a resident requested some of their own money as they decided to go out to have a haircut, but did provide the resident with money left over from taxi money. Staff advised that they were unable to access residents’ monies and financial records when requested for inspection. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ benefit from a clean and comfortable home that meet their needs, although safer storage of hazardous products would better safeguard them. EVIDENCE: Central Avenue was pleasant and homely with residents having ample communal space, including a lounge, a large kitchen dining room and a pleasant garden. Some areas, particularly the lounge, are dated and would benefit from refurbishment. The AQQA also identified that some internal redecoration to modernise parts of the house was an identified area for development. All residents have a single bedroom giving them some privacy. Most residents were able to show their own bedrooms and able to say or indicate that they liked their rooms and found them comfortable. One resident advised that they 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 19 had been involved in choosing the décor to reflect a personal interest and other bedrooms were personalised and individually decorated. The premises are well maintained and a record was kept to show how quickly maintenance issues are actioned to keep the house a nice, safe place for residents, an issue from the last inspection that the staff team had carried out. Staff and residents confirmed that residents had had baths that morning. The thermometer for testing the water could not be found, an issue also identified in the last inspection report. Staffs’ attention was drawn to areas in the home where hazardous items (C0SHH) were not safely stored, with keys left in the locks, and so presenting a risk for residents. New cleaning schedules have been introduced and the premises were clean throughout, which is a positive development from the last inspection. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at 2 Central Avenue are supported by a competent team but they would benefit from the consistency of more permanent staff. The records on staff recruitment and training practices do not best safeguard residents in all cases. EVIDENCE: The AQQA identifies that the majority of permanent staff had achieved at least NVQ level 2 and the remaining staff were working towards achieving this. There was no evidence of agency staffs’ achievements in relation to NVQ training. Staff and residents interacted comfortably with each other with staff listening to residents’ wishes and needs and responding to these. Comments received from other stakeholders referred to staff team generally as lovely, friendly and kind but lacking motivation in relation to daily activities for residents. Including the manager, Central Avenue employs four full-time permanent staff, one of whom is currently on long-term leave, and three part time permanent 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 21 staff. The rota shows use of number of agency staff most of whom are regulars, with permanent staff also covering occasional additional shifts to support consistency of care for residents. Both agency staff on duty at the time of the site visit were heard to address the residents by name and were able to identify their individual general care needs and behaviours. As noted they were unclear as to the management plan of a resident’s finances in practice. The agency staff were unable to provide access to staff recruitment files on request as they advised that they were unaware of where they were kept. This has been an issue raised with Estuary in the past where they agreed management were to ensure that the person left in charge of the home had clear information on providing access to these documents should an inspection occur. Information taken from the AQQA, the last inspection report and the rota shows that no new permanent staff had been employed at the home. Profiles were available in relation to several of the agency staff names sampled from recent rotas, but not for one of the staff on duty. The profiles confirmed that the agency had undertaken the required checks on these staff to safeguard residents. Photographs were not available on all of the agency staff profiles and no profiles were available for two other one of the staff recently used to provide care for residents. Both agency staff on duty had evidence of their identity and a copy of their training records, which were comprehensive and up-to-date. Agency staff profiles sampled confirmed that staff had undertaken a range of training and updates to enable them to support residents effectively including for example moving and handling, emergency first aid, infection control, health and safety and in most cases protection of vulnerable adults. Some staff also had evidence of medication training. Evidence of up-to-date training for agency staff is a noted improvement from the last inspection. Training files sampled for permanent staff did not have individual matrices, but did have certificates to evidence that staff have access to regular basic training issues such as moving and handling, fire, food safety and protection of vulnerable adults, but did not have evidence in some cases of recent medication training/competence assessments. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at to Central Avenue have limited opportunities to express their views. Internal leadership lacks energy to develop the service in some areas, although improvements are noted. External management does not best protect the resident’s interests. EVIDENCE: The manager was on leave at the time of the inspection site visit. The senior agency staff on duty telephoned Estuary’s on-call system at the start of the site visit advising them of its occurrence and that two agency staff were on duty, but no additional support was provided by Estuary. The difficulty presented to the agency staff is acknowledged and there was no other system in place to support them to manage this, for example to advise them of records that could be inspected, and how to access these. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 23 This report shows that the manager and staff team have acted positively on several of the issues identified in the last inspection report. The managers training file shows up-to-date training in moving and handling and training on other issues such as autism, risk assessment, epilepsy and management of challenging behaviour. There was no evidence of any medication training, or of updated protection of vulnerable adults training, following the lack of effective reporting identified earlier in this report. As identified in the last inspection report, evidence available indicated that the last quality review was undertaken in April 2005. The AQQA identified a need to produce service user-friendly questionnaires, but no evidence could be found that these had been implemented to gain residents’ views of the service. Records available showed that the last service user meeting was dated February 2006. Records available showed that the last monthly audit of the home undertaken by Estuary was February 2007 although the last inspection report identifies that another had been undertaken in June 2007. The last two inspection reports required Estuary to undertake these so that they could reassure themselves that the home was running in a way that supported the residents best interests. Aspects of health and safety management were sampled. Current safety inspection certificates were available relating to portable appliances, the fire alarm and the emergency lighting. The certificate relating to fire equipment had recently expired. Current certificates were available relating to fixed electrical wiring and gas. Records showed weekly checks of the hot and cold water temperatures. Entries recorded for each of the bedrooms and the bath over a two-month period remained consistently repetitive and mirror exactly those recorded as repetitive in the last inspection report for each of these outlets and so the accuracy of these may be questioned. The emergency lighting is tested inhouse every three months. 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 X 1 X X 2 X 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA12 YA13 YA14 Regulation 16(2) m&n Requirement To ensure quality life outcomes for residents, they must be given the required support to regularly experience a range of meaningful activities, both at home and in the community, and that meets their individual and assessed needs. Previous timescales of 01/08/06 and 31/10/07 not met. 2. YA24 13(4) To safeguard residents hazardous items such as cleaning materials etc. must be securely stored. 18/12/07 Timescale for action 01/02/08 3. YA34 19 (1) (a) (i) Schedule 2 To safeguard residents the 18/12/07 manager must ensure that he does not employ a person to work at the care home unless he has evidence that all appropriate references and checks have been obtained in respect of that person. The manager must ensure that 01/02/08 he has up to date knowledge and training relating to safeguarding vulnerable people and safe DS0000018072.V355139.R01.S.doc Version 5.2 Page 26 4. YA35 YA37 18(1) 2 Central Avenue management of medication. 5. YA37 9(2)(i) 37 (1 & 2) To safeguard residents and demonstrate appropriate knowledge and competence, the manager must inform the commission of all events that affect the well-being of a resident as shown in Regulation 37. To ensure that the home is running in a manner appropriate to the needs of the residents the registered provider must undertake regular monthly visits to the home under Regulation 26 and prepare a written report on the conduct of the home. Previous timescales of 01/08/06 and 30/10/07 not met. 7. YA39 24 To ensure the quality of the service provided the manager and registered provider must introduce an effective system for monitoring it and include methods to obtain the views of residents in a format that meets their needs. To ensure the wellbeing of the residents and staff at the home, the manager and registered provider must ensure the maintenance and inspection of the fire equipment and monitor the effectiveness of the water temperature audit. The latter issue is outstanding from the last inspection 01/02/08 18/12/07 6. YA39 26 (2) (3) (4) (5) (c) 01/02/08 8. YA42 23(4) (c) 13 (4) (c) 18/12/07 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 27 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 YA6 YA20 Good Practice Recommendations Residents input to their care plan should be clearly evidenced. Medication administration records should record the start date of each new cycle of medication to assist clear auditing and safeguard residents. To safeguard residents, all staff including agency staff, should be given access to a clear information on whistleblowing, including contact information. To safeguard residents clear procedures should be in place from admission to support residents who manage aspects of their personal finance. To ensure resident safety a thermometer should be available to test the temperature of the bathwater. To ensure that resident are cared for by competent staff, the registered provider should ensure that regular agency staff have achieved appropriate NVQ training, particularly on shifts where residents are supported only by agency staff. To ensure that resident are cared for by competent staff, the registered provider should continue efforts to recruit more permanent staff and endeavour to ensure that agency staff work alongside permanent staff. 3. YA23 4. YA23 5. 6. YA24 YA32 7. YA33 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 2 Central Avenue DS0000018072.V355139.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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