Inspection on 26/09/07 for 21a & 21b Johnson Avenue

This inspection was carried out on 26th September 2007.

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

21a & 21b Johnson Avenue 09/06/06

21a & 21b Johnson Avenue 08/12/05

21a & 21b Johnson Avenue 18/08/05

21a & 21b Johnson Avenue 27/10/04

21a & 21b Johnson Avenue 23/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 21a Johnson Avenue Spalding Lincolnshire PE11 2QE Lead Inspector Tobias Payne Unannounced Inspection 26 September 2007 9:50 th 21a Johnson Avenue DS0000002491.V340862.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 21a Johnson Avenue DS0000002491.V340862.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. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 21a Johnson Avenue Address Spalding Lincolnshire PE11 2QE 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) 01775 767472 pat.morris@sense.org.uk www.sense.org.uk Sense, The National Deafblind and Rubella Association Mrs Patricia Morris Care Home 7 Category(ies) of Learning disability (3), Sensory impairment (4) registration, with number of places 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 21a Johnson Avenue is registered to provide personal care and accommodation to service users who fall under the following categories: Sensory Impairment (SI) 4 2. Learning Disability (LD) 3 The total number of persons to be accommodated at 21a Johnson Avenue is 7 9th June 2006 Date of last inspection Brief Description of the Service: 21a Johnson Avenue is made up of 2 linked detached houses owned by Sense East. Since September 2006 both 21b and 21a (which were registered separately) have been registered as one care home under the responsibility of one manager and 2 deputy managers. The property is domestic in design and in keeping with other houses in the road. The home is situated in a residential area of the market town of Spalding and is within walking distance of the town centre. The home is registered to provide personal care for up to 7 people with dual sensory impairments. It is part of a group of homes in the area, managed by Sense. There is a small garden/patio area to the back of the home and all of the residents live in single bedrooms. The fees at the inspection visit on the 26/9/2007 ranged from £946.86p to £1,336.87p each week. There are extra charges for hairdressing and personal toiletries. The statement of purpose, service user’s guide and any information about the home can be obtained from the manager. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit, was unannounced and started at 9.50 am. We reviewed all the information we had about 21a Johnson Avenue. In view of the communication needs of the residents we relied on observations between staff and the residents, information provided by staff members and records as evidence as to whether standards were being met. The main method of inspection was called “case tracking”. This involved tracking the care for 2 residents. This was done by the checking of records; discussions with 2 care staff, and the 2 deputy managers. We also observed how their care was delivered. We also examined an Annual Quality Assurance Assessment completed by the manager. What the service does well: What has improved since the last inspection? What they could do better: Once again, there were no requirements or recommendations. Where there are issues for improvement, Sense, the management and staff are already considering how the quality of life and individual choices for the residents could be improved. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 6 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. 21a Johnson Avenue DS0000002491.V340862.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 21a Johnson Avenue DS0000002491.V340862.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): Standards 1 and 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is clear and detailed information about the home in a variety of forms to enable residents and their relatives/advocates to make an informed choice about whether or not they wish to live in this home. Residents receive a comprehensive assessment, which results in their needs being met. EVIDENCE: No new residents have been admitted to the home since 2001. There was therefore an established community. Both 21b and 21a Johnson Avenue had been registered as one home since September 2006. This had been very smoothly carried. The statement of purpose and service user’s guide had been changed to reflect these changes. These could be produced in large print, Braille, CD Rom, pictorial symbols and languages other than English. Where a new person was referred the Sense Assessment Co-ordinator then the Referral Team and then the manager would assess them thoroughly. Information about each resident would be obtained where possible from the resident, their family or other relevant people. Written confirmation would be sent to confirm that the home could meet their needs. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 9 Staff as part of their induction, received information about each resident to enable the member of staff to understand their needs and how to support them. A new member of staff confirmed that they had received a very comprehensive and supported induction, which had given the person confidence to support each resident. 21a Johnson Avenue DS0000002491.V340862.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): Standards 6, 7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by comprehensive person centred care planning and staff know and understand how to meet the needs of the residents. Residents are supported and helped to make decisions about their lives. EVIDENCE: Each person had a care and support care plan. This included a photograph, pen picture, outline of their background, skills and abilities, emotional needs and interests, food preferences, daily routine and a daily record. There were comprehensive risk assessments about all aspects of daily living activities. Since the last inspection visit, new detailed and person centred “my health plans” had been introduced for each resident. This covered in great detail each residents health needs. There was clear information to enable staff to care/support and promote the independence of each resident. There were review dates and the care plan was reviewed month. Each resident also had a 6 monthly review which included wherever possible each resident, their family/advocate, a representative from the Glenside Resource Centre, the 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 11 resident’s key worker and the manager of the home. Care plans were individual and the daily records well written, factual and dated. Residents were given choice about their food, interests and activities. This was shown by 2 residents during our inspection visit on their “at home day” choosing what they wished to do with the support of the staff. Staff were also trained to assist them. We checked the residents’ financial records and could see that clear records were being kept. 21a Johnson Avenue DS0000002491.V340862.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): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents were involved in meaningful, appropriate activities, which include educational, work, and recreational activities. Staff had the knowledge to support them in these activities. Meals provided were nutritious and varied. EVIDENCE: Each resident had an individual activity programme, which had been produced with their involvement. All residents attended the purpose built Glenside Resource Centre operated by Sense Monday to Friday. Activities were varied and included, cookery, pottery, horticulture, creative art, office skills, personal and social development, music, numeracy and literacy, local history and citizenship. A mini-bus takes them there between 9.30 am and 4pm. In addition 2 residents were on work placements. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 13 Each resident had an “at home day” at which they could decide what they wished to do with the support of their key worker. We saw this during our inspection visit when 2 people were at home. They got up when they wished to do, had breakfast and went out for the day with their key worker. Activities included visits into town, garden centres, hairdressers, gymnasium, swimming, eating out and horse riding. On return from the day care activities, there was a programme of evening activities, which had been arranged following discussions with the residents. Each resident had an annual holiday and 4 had gone for a 5 day holiday to a holiday complex in Nottinghamshire and 3 were preparing to go on holiday to the Lake District. Staff had consulted with the residents about where they wished to go. Residents also go on holidays and spend time with their family. Each resident assisted in food preparation and 2 cooked their own food with staff supervision as part of their risk assessment. Independence was clearly seen and staff spoke of wishing to further develop the residents’ independence and empowerment. There was a packed lunch, which they prepared when going to the day centre and a hot evening meal including a choice. Residents were involved in choosing what they could eat and the menu was also in Braille. All staff had received food hygiene training, as they are required to prepare meals. Residents received nutritious food. 21a Johnson Avenue DS0000002491.V340862.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): Standards 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and emotional needs are met and staff know their needs. Medication is safely given by staff who know what they are doing. Residents are protected by clear medication policies. EVIDENCE: There was community nurse involvement where required and each person was registered with local GPs. There were no major healthcare issues. There was also active involvement of dentists, opticians and hearing services. Each person also had a very detailed, clearly written health record, which gave comprehensive details of their health needs. There was a very detailed medication policy and each member of staff received medication training and had their practice assessed before being considered safe and competent to give medication. We were told of a medication error which had occurred which had caused no ill effects to the resident. As a result of this the staff had been retrained and their practice monitored. We had no criticism of the efforts made by Sense to address this issue. There was a pharmacy visit on the 23/7/2007 with no concerns. Medication records were correctly being recorded. There was a record kept of staff signatures. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 15 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): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints received are treated properly and residents and visitors know that any concerns they make would be addressed and taken seriously. Staff are recruited correctly to ensure that residents are protected from abuse. EVIDENCE: The home and we had received no complaints since the last inspection. Sense had a detailed “resolving Issues” policy, which gave written and pictorial information about how a resident could raise any issues. This could be produced in Braille, tape or in languages other than English. The home had an adult protection policy and all staff as part of their induction received abuse training. The Lincolnshire Adult Protection policy was also available. They also received a refresher annual training. A member of staff present knew about abuse and what they would do if abuse was suspected. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 16 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): Standards 24, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, clean, well decorated and comfortable home. This suits the needs of the residents. EVIDENCE: The home was clean, comfortable, safe and odour free throughout. Since the last inspection a great deal of decoration and refurbishment had taken place. Both houses had been repainted to improve the environment and furniture rearranged to suit the individual needs of the residents. In addition bathrooms had/were being refurbished and new kitchens had been provided in both houses. Efforts had been made to ensure that each resident was involved in choosing colours and furnishings. Residents’ rooms were individual and they were encouraged to make their rooms personal with beds, furniture, television, HiFi, pictures and personal mementoes. All bedrooms had locks to enhance their privacy. There was a master key for staff to use in case of an emergency. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 34, 35 and 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are safe, stable levels of staff and staff know how to meet the residents’ needs by receiving comprehensive programmes of education. Staff are also supported in their work. EVIDENCE: Each member of staff was responsible for care, catering, domestic and laundry duties. Both houses had sleep in staff, as there were no wakeful staff on duty. However, where required additional help would be provided. Staff were available in the home whenever residents were in the home. On the residents “at home” day a member of staff gave one to one attention/support. Staff were recruited correctly with an application form, 2 references and Criminal Records Bureau check. A new member of staff confirmed this had taken place and commented, “I received a warm welcome and a supported induction which prepared me for my work. We have a brilliant staff team and everyone has been helpful and welcoming”. . 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 18 Staff also spoke of the training and support provided to give them the skills to care and support the needs of the residents. Each member of staff had an individual training programme. Training included a 12 week induction programme during which they were supported. After this they were offered training in care (National Vocational Qualifications) of which 65 of the staff had obtained this. In addition training had also included British Sign Language, first aid, moving and handling, medication, fire safety, safeguarding adults, crisis prevention, and food hygiene. Throughout our inspection visit we saw staff taking time, in an unhurried manner to communicate, support and encourage residents in a calm and sensitive manner. Each member of staff received formal supervision sessions every month. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39, 40 and 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. An experienced competent management and staff team meets the day-to-day needs of the home. EVIDENCE: The manager was now responsible for what were 2 separately registered homes. There had been a successful transition with her work being supported by 2 deputy managers. Each had responsibility for one of the houses. However, the staff met and worked as one team. The manager had been the manager since 2005 and had extensive care and managerial experience. She was also an assessor and had a management qualification. Staff felt confident in the management style and commented, “I find the manager approachable and supportive”. There were regular staff meetings. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 20 There were detailed policies and procedures, which also referred to equality and diversity. Throughout the inspection we saw staff understanding and respecting the diverse needs of the residents in the home. The manager was also aware of the Mental Capacity Act 2005. The Annual Quality Assessment completed by the manager was to a high standard. Sense made monthly unannounced monitoring visits and detailed reports had been sent to the Commission. There were no concerns and any issues, which arose, were professionally addressed by Sense. Staff spoke of wanting to devise new approaches to further promote independence and empowerment of the residents. Recent questionnaires had been introduced using pictures and symbols to obtain views from residents about how they felt about the home. This had proved successful. Records examined on the day of our inspection visit were available, well maintained and up to date. The home had a comprehensive and detailed health and safety policy together with detailed risk assessments covering all aspects of daily living activities. A detailed fire risk assessment had also been carried out. There were regular tests of the fire system as well as regular fire drills. 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 21 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 4 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 4 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 3 14 x 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 4 3 3 X 3 x 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 22 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. 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. Refer to Standard Good Practice Recommendations 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 21a Johnson Avenue DS0000002491.V340862.R01.S.doc Version 5.2 Page 24 - 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. 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