Inspection on 05/12/05 for 2 Central Avenue

This inspection was carried out on 5th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 18/12/07

2 Central Avenue 04/07/07

2 Central Avenue 01/08/06

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 Central Avenue (2) 2 Central Avenue Billericay Essex CM12 0QZ Lead Inspector Mrs Bernadette Little Unannounced Inspection 5th December 2005 12:15 Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 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 Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 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. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Central Avenue (2) 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 Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20 July 2005 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 to admit people up to the age of 65, and to continue to care for those who live there already and reach the age of 65. The premises comprise of a bungalow with four single bedrooms, a bathroom, and lounge, kitchen/dining room and a small conservatory area with access to a large garden at 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. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second routine unannounced inspection of 2 Central Avenue for this year, and it took place on a Monday afternoon. The two agency staff on duty and all residents were chatted with The registered manager was not at the home at the time. Time was spent looking at records and all parts of the premises. The help provided by the residents and staff was appreciated. Any standards not covered at this inspection were considered at the last inspection. What the service does well: What has improved since the last inspection? What they could do better: The home need to make sure that there are staff on duty at all time who can drive so that they can take residents to their day centres. Residents should also have more chances to do ordinary things in the community. Estuary need to make more efforts to get things done in the premises, for example to make the laundry clean and safe, or put a safe lock on the toilet/bathroom door to give residents some dignity. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 6 Estuary also need to make sure that they have written confirmation from the agency that all required references and checks had been completed for each staff member, before they come to work at the home. A copy of the identity record for each agency staff could be kept in the same way as their training records. 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. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 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 Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5 Central Avenue had a good range of information available for those thinking about using the service. EVIDENCE: While it was undated, the statement of purpose had been amended to identify that the home does not only care for male residents. The service user guide available in the home was dated September 2004 and continued to state that the home cared for four male residents, which is inaccurate. The residents’ pictorial statement of terms and conditions identified what the homes charges included. Staff spoken with advised that residents were not charged for any additional items, but did pay for personal toiletries chiropody etc. Receipts for these were available. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 Care plans were of a good standard with plenty of detail to support staff to provide individual quality care to residents. The detail of the risk assessment regarding the bed rails along with the practice seen did not best protect residents. EVIDENCE: One of the four care plans were sampled on this occasion. This contained a wealth of information on the resident’s individual needs and how they are to be met in a practical daily basis. These were supported by risk assessments. Care notes were written regularly and made reference to the care plan. Later inspection of the premises, and this residents bedroom identified some concerns that were advised to the staff on duty. This referred mainly to the gap between the mattress and the bed rails being used. Staff advised that this was not the resident ‘proper’ bed, which was on order and awaited. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13 Residents were not being provided with appropriate or agreed opportunities to maintain a fulfilling lifestyle or community presence. EVIDENCE: Each resident had a weekly plan of activities. Three of the four residents at home during the inspection should have been at their day centres. Staff confirmed that this had not occurred because there were no drivers amongst the staff team able to take them. Apart from Monday at the day centre, the care plan sampled showed that the resident would have a drive out on Tuesday, stay at home Wednesday and Thursday watching TV, drawing or listening to music and suggested a trip out on Saturday and Sunday. This resident’s assessment identified that they are a social person and enjoys going to the pub, parties, outings and any social occasions. There was limited evidence in the activity plan or care notes to confirm that the resident was part of the local community or took part in many appropriate social and leisure activities. It was noted that the resident had attended a party recently. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 Residents’ health care needs were effectively identified and met. The medication system was assessed as safe. EVIDENCE: Health care needs were included as part of the main care management file for each resident. The separate area identified the date of the event, the healthcare professional involved, the reason for the visit the outcome and any follow-up. This was tracked for one resident as part of the care plan and identified the involvement of several appropriate healthcare professionals including a change to liquid medication as appropriate. It was noted positively that the PRN (as required) medication protocol had recently been reviewed. Staff advised that rectal diazepam was not administered as there has been insufficient training/updates, and instead the GP/emergency services would be called. All other aspects of the medication system sampled were satisfactory. Records of medication administration training/competence assessment and a sample of their signature was not in place for all staff. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Arrangements for protecting residents were satisfactory. EVIDENCE: The training files for the seven permanent staff at the home confirmed that they had all had training both on the protection of vulnerable adults and on the management of behaviour that challenges. It was also noted positively that there was a record for the two agency staff on duty to confirm that they had each attended both of these training sessions. Staff were clear in discussion on appropriate actions to take. There is an outstanding recommendation regarding the whistleblowing procedures being written in plain language. It has been confirmed by Estuary that an application has been made for this to be undertaken. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 29, 30 Central Avenue would provide a better and safer living environment for residents with more timely attention to maintenance and the provision of appropriate equipment. EVIDENCE: Central Avenue provided a homely environment. A planned programme of maintenance was not available. The wash hand basin had at last been replaced in a residents bedroom. The vanity unit was not in place and this needs to be addressed. The lock on the bathroom/toilet door or was again not working properly thus not offering residents privacy and dignity. A comment is made in National Minimum Standard 9 in relation to an appropriate bed for a resident being required. The laundry continued to be a concern. There was no hand washing facility, the wall and floor surfaces were in poor condition and did not support good infection control measures, and the room was also used for the storage of food. These concerns have been advised to Estuary in the previous inspection report and they provided written confirmation that they would be addressed by November 2005. This needs urgent attention. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Staff were provided with appropriate training to enable them to effectively meet residents’ needs. Recruitment records did not evidence good practice to protect residents in all cases. EVIDENCE: Staff on duty advised that four of the permanent staff were correctly undertaking NVQ training. This was also confirmed in the visitor’s record book. While the agency staff on duty clearly knew the residents well and records demonstrated that they had worked regularly at Central Avenue for some time, the effectiveness of the staff team has been raised as a concern in the section earlier in this report on Lifestyle. Recruitment files were examined for two permanent staff. These were appropriate apart from the lack of evidence of identity on one file. Original criminal record bureau checks were available for all permanent staff with the exception of the manager, where a copy was available. Neither of the agency staff on duty had identification with them. One had a record of the number of their Criminal Record Bureau check. The other agency member of staff advised that they had not had a criminal record bureau check, which had been discovered when the home’s manager recently asked the agency for confirmation. They advised that an application had recently been made. In a telephone conversation the agency confirmed that this was Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 15 accurate but they could not provide evidence of a Povafirst check having been done in the interim. Advice was provided on taking immediate action. Training files and a training plan were well organised. They demonstrated that permanent staff had had training in basic mandatory subjects, including recent fire training, as well as some service user specific issues. It was also noted positively that copies of the training records of agency staff were maintained on a separate file. It was not possible to access confirmation of supervision through the records on this occasion. There were no permanent staff on duty to confirm that supervision occurs regularly. A supervision plan was displayed. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 43 Central Avenue presented as well organised with systems in place to provide a safe home for the residents. EVIDENCE: The manager’s training file evidenced regular and appropriate training courses. Estuarys quality network statement (April 05) was available. This identified one of the main areas where services need to improve as being in providing better leisure and work opportunities for residents. Monthly reports as required under Regulation 26 had been undertaken and copies sent to the Commission. A letter on the resident’s file sampled confirmed that the family were invited to attend the next service user meeting, later this month. There was limited evidence available that effort had been made to gather the views of the residents on the home. A current certificate of liability insurance was displayed. From observations during this inspection and discussion with the staff there was nothing to indicate that the home is anything other than financially viable. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 17 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 2 X X X 3 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 X 2 X 2 2 LIFESTYLES Standard No Score 11 1 12 1 13 1 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 2 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Central Avenue (2) Score X 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X 3 DS0000018072.V269919.R01.S.doc Version 5.0 Page 18 YES 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 YA9YA29 Regulation 13(4)(C) 16(2)(C) Requirement Timescale for action 05/10/05 2 3 4 5 The person registered must ensure that all resident are provided with equipment appropriate to their individual needs and all risks are identified and as far as possible removed. YA11YA12YA13 16(2)(m) The person registered must ensure that residents are enabled to engage in social and community activities. YA27 12(4)(a) The bathroom door to be fitted with an appropriate lock to allow residents privacy and dignity while ensuring their safety. YA30 23(2)d,13(3) The person registered must ensure that appropriate facilities are available in the laundry to manage the risk of infection. This refers to hand washing facilities, appropriate wall and floor coverings. (previous timescales of 20/07/04 and 01/10/05 not met) Additionally the storage of food in the laundry to be reconsidered. YA33 18(1)a, b & The person registered must DS0000018072.V269919.R01.S.doc 05/12/05 05/12/05 01/01/06 05/12/05 Page 19 Central Avenue (2) Version 5.0 c 6 YA34 18,19, Sch 2 &4 7 YA34 Sch 2 & 4 as amended 24 8 YA39 ensure staff employed at the home have the skills to meet residents needs. This refers only to ensuring staff on duty are able to drive residents to their appropriate activities or to provide alternative safe arrangements The person registered must 05/12/05 ensure that Criminal record Bureau checks are carried out for all agency staff working in the home. (Previous timescale of 01/02/05 and 20/07/05 not met). The person registered must 01/01/06 provide evidence of the identity of all staff working at the care home. The person registered must 01/01/06 implement and maintain an effective system for gathering the views of residents and other interested parties as to the conduct of the home.(Previous timescale of 20/07/05 not met) 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 3 Refer to Standard YA1 YA20 YA20 Good Practice Recommendations A copy of the updated service user guide should be available in the home. An up to date sample of staff initial/signatures should be available Evidence of medication competence assessments should be available for all staff involved in medication systems, DS0000018072.V269919.R01.S.doc Version 5.0 Page 20 Central Avenue (2) 4 5 6 7 8 9 YA23 YA24 YA25 YA32 YA36 YA37 once completed. The whistleblowing policy and procedure should be written in clearer language. A planned programme of maintenance for all works within the home should be available for inspection. The works to the sink/vanity unit in a resident’s bedroom should be actioned without any further delay. 50 of care staff should achieve NVQ training Staff should have formal supervision at least six times annually. The registered manager to achieve NVQ4 in Care and Management. Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Central Avenue (2) DS0000018072.V269919.R01.S.doc Version 5.0 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!