Inspection on 09/06/06 for 21a & 21b Johnson Avenue

This inspection was carried out on 9th June 2006.

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 26/09/07

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 Mr Toby Payne Unannounced Inspection 9th June 2006 08:55 21a Johnson Avenue DS0000002491.V298382.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.V298382.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.V298382.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 East Mrs Patricia Morris Care Home 4 Category(ies) of Learning disability (0), Sensory impairment (4) registration, with number of places 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th December 2005 Brief Description of the Service: 21a Johnson Avenue is one of a pair of detached houses owned by Sense East. Sense recently celebrated their 50th Anniversary. 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 4 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 on the 9/6/2006 ranged from £1,007 to £1,397 each week. There are extra charges for hairdressing and personal toiletries. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was part of the key inspection, was unannounced and started at 8.55 am and took place over 3½ hours. It was undertaken using a review of all the information available to the inspector regarding our information about 21a Johnson Avenue. In view of the communication needs of the one resident living in the home at this inspection, the inspector relied on observations between staff and the person, information provided by staff members and records as evidence as to whether standards were being met. The other 3 residents were on holiday and therefore not in the home at this inspection. The main method of inspection was called “case tracking”. This involved tracking the care for the one resident. This was done by the checking of records, discussion with 2 care staff, the deputy manager and observation of how their care was delivered. Comment cards were received on behalf of the 4 residents. The key worker had filled them in after consultation with the resident. The manager had also completed a pre-inspection questionnaire. What the service does well: What has improved since the last inspection? The hot water system has improved and residents now have a more constant supply of hot water. The patio has been relayed at the back of the home to make it safer for the residents to use. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 6 A new washing machine has been purchased. 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. 21a Johnson Avenue DS0000002491.V298382.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.V298382.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Residents living at 21a Johnson Avenue receive clear information to enable them or their relatives/advocates to make an informed choice as to whether or not they wish to live in this home. Staff receive comprehensive training to understand the needs of people living in to the home. EVIDENCE: No new person had been admitted since 1993. There is a statement of purpose and service user’s guide for the home. These can be produced in large print, Braille, CD Rom, pictorial symbols and languages other than English. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 9 If a new person was admitted to the home the Sense Assessment Co-ordinator and then the Referral Team would assess the person initially. The manager would then undertake an assessment of the person’s needs. Staff, as part of their induction receive information about the people living in the home to enable them to support them. Information would be obtained where possible from the resident, their family and other relevant people. Written confirmation would also be sent to confirm that the home could meet their assessed needs. 21a Johnson Avenue DS0000002491.V298382.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 at least once during a 12 month period. 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 the available evidence including a visit to this service. There is detailed care planning which includes risk assessments. The health, personal and social care needs of people living in this home are fully met. EVIDENCE: Each resident had a detailed care plan. This was produced wherever possible with the involvement of the resident, their family/advocate and other relevant people. Care plans included a pen picture, which outlined their background, skills and abilities, emotional needs, hobbies and interests, food preferences, their daily routine and a daily record. There were also comprehensive risk assessments covering all aspects of daily living activities. There were also 6 monthly detailed reviews which again include wherever possible the resident and their family/advocate, representatives from the Glenside Resource Centre, the resident’s key worker and manager for the 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 11 home. Before this there is a meeting to obtain all information concerning the resident. Residents were given choice concerning their interests and activities. This was shown by the resident choosing what she wished to do on the day with the support of staff. Staff receive training in order to assist them. Resident’s financial records were checked and clear records were being kept. Care records were seen to be very individual and person focussed. 21a Johnson Avenue DS0000002491.V298382.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 and 16 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. People are involved in meaningful, appropriate activities, which include educational and recreational activities. They also receive a varied, nutritious and wholesome diet. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 13 EVIDENCE: When being admitted to the home details are obtained concerning each person’s food preferences, likes and dislikes and their lifestyle. All residents attend the purpose built Glenside Resource Centre in Pinchbeck operated by Sense. The activities available include cookery, pottery, horticulture, creative art, office skills, personal and social development, music, numeracy and literacy, local history and citizenship. A mini-bus takes residents to the centre between 09.30 and 16.00 hours Monday to Friday. Arrangements can also be made for massage and there is a physiotherapy/sensory room and coffee shop. The weekly “at home” day allows residents to decide and choose what they wish to do. This can include shopping, visits into town, hairdressers, gymnasium, swimming and horse riding. Residents also go on holidays and spend time with their family. Three of the residents were on holiday with their families on the day of the inspection. The one person in the home went out for the day accompanied by two members of staff to Skegness. This was what she wanted to do and she did this having chosen what she wanted to have for breakfast with staff support. Care records clearly showed that any health or emotional needs were being met either by staff, specialist staff from Sense East or by the GP. Staff also showed knowledge of the particular needs of the residents. There were also detailed policies and procedures to enable staff to deliver their care and support. At breakfast there is a choice including a hot meal. At lunch, when attending the Glenside Resource Centre (run by Sense), there is a packed lunch and an evening meal provides a hot meal including a choice. People can choose what to eat and the menu is in Braille. The week’s menu is also displayed in pictures. All of the people living in the home as part of their risk assessment cook with staff supervision. Meals are taken in the dining area in the lounge on the ground floor. All staff are required to prepare meals and all have food hygiene training provided. The nutritional content of the menu is monitored. 21a Johnson Avenue DS0000002491.V298382.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Resident’s health and emotional needs are met. Efforts have been made to ensure that medication is safely and correctly administered. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 15 EVIDENCE: Where required, the Community Nurse provides any nursing care. Residents can be referred to GPs, Community Nurse, Dentists and Opticians. Where required, other services can be obtained. Sense have a very detailed and clearly written medication policy. The CSCI has been informed of 2 medication errors since the last inspection. No resident suffered any ill effects and Sense have taken this issue very seriously by retraining all staff responsible for the administration of medication, undertaking daily monitoring and weekly audits of medication. The manager and deputy manager have also attended a very detailed training course by Boots. A detailed audit and analysis of the medication by a pharmacist will take place inn the future. There is no criticism of the efforts made by Sense to address this issue. On account of their sensory impairments, none of the residents were selfmedicating. 21a Johnson Avenue DS0000002491.V298382.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Any complaints received are taken seriously and residents are protected from abuse. EVIDENCE: Sense East have produced a “Resolving Issues” policy, which gives written and pictorial guidance concerning how a resident can raise any issues. This can be provided in Braille, tape or other languages other than English. No complaints have been received by the CSCI and the home since the last inspection. The home has an adult protection policy and all staff as part of their induction receive abuse training. They also receive a yearly refresher training programme in the form of a questionnaire at their appraisal. A member of staff who was appointed in January 2006 knew what abuse was and what they should do if abuse was suspected. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. People live in a safe, clean and well decorated, comfortable home. EVIDENCE: The home is a domestic house with a small garden with patio furniture and shed at rear. All residents have their own bedroom. All residents are encouraged to bring personal possessions into the home. This can include a bed, furniture, television, HiFi, pictures and personal mementoes All bedrooms apart from one on the first floor have a washbasin. The reason for this is on account of it not being possible to install a waste pipe. All bedrooms have locks to enhance the resident’s privacy. The home however, has a master key for staff to use in case of an emergency. Where required, advice can be obtained from a Sense Rehabilitation Officer or Occupational Therapist. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 18 The home was clean and odour free throughout. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 19 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, 34 and 35 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. There are safe levels of staff and staff know how to meet the resident’s needs by a comprehensive programme of education. Staff are supported in their work. EVIDENCE: All staff are responsible for care, catering, domestic and laundry duties. Sleep in cover is provided in the home, as there are no wakeful staff on duty at night. However, where required additional help can be provided. The staff felt they could meet the needs of the residents and felt they had sufficient time. This was observed during the inspection by staff taking particular time to communicate to a resident in a calm, kind and sensitive manner. Staff also spoke of the support provided and how they all worked as one team. Staff also spoke of the training provided to enable them to care and support the people living in the home. This training also includes how to sign in order to communicate with the people living in the home. Staff also receive formal supervision to identify any training needs or support required. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 20 During the inspection, the inspector spoke to 2 members of staff who showed awareness of their role and spoke of their commitment to the home and people living in the home. The home has a detailed and comprehensive recruitment and equal opportunities policy. All staff have been recruited in accordance with the regulations. All staff have received checks by the Criminal Records Bureau. Each member of staff has an individual training programme. Training includes, induction, foundation and training in care (NVQ). Sense have arranged for all manager’s to have undertaken person centred planning training in order to identify any issues where the quality of life of any person living in the home can be improved. This training is enabling staff to focus on the specific needs of one person in the home. The home has a training budget. All staff receive a detailed induction programme. Other training can be provided to meet the changing needs of the residents. Each member of staff receives formal supervision sessions every month. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 21 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, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Staff are lead by an experienced, competent and committed manager who supports the staff and residents. Staff have confidence in the management. EVIDENCE: The manager has worked for Sense East since 1991 and has a wide experience in care and management. This has included learning disability, sensory impairment and mental disability. She has been the registered manager since the 25/4/2005 and has care, education and management qualifications. She is also an assessor. Staff felt confident in the management. Comments were, “everyone has been very friendly and supportive” and “I have noticed how relaxed the residents have been”. Regular staff meetings are held and examination of the minutes of the most recent meeting on the 6/6/2006 showed they were focussed on meeting and addressing both the staff but also the resident’s needs. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 22 The home has comprehensive policies and procedures, a number of which are in line with the National Minimum Standards. Sense also have their own comprehensive quality standards. A number of these procedures were reviewed in 2005. Sense have a policy on equality and diversity. The deputy manager acknowledged that one of the residents dietary and cultural needs, required to be addressed further as did the religious needs of the residents. Records examined on the day of the inspection were available, well maintained and up to date. Sense also undertake monthly unannounced monitoring visits and detailed reports have been sent to the Commission. Internal audits are carried out every 6 months, the last taking place in June 2005. The home has 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. Radiator covers have been installed throughout the home in all areas which are accessible to people living in the home. 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 23 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 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 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x 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 3 13 3 14 x 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 x x 3 x 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 24 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.V298382.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 21a Johnson Avenue DS0000002491.V298382.R01.S.doc Version 5.2 Page 26 - 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!