Inspection on 18/07/05 for 27 Graham Avenue

This inspection was carried out on 18th July 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 but made no statutory requirements on the home.

Other inspections for this house

27 Graham Avenue 10/05/07

27 Graham Avenue 27/09/06

27 Graham Avenue 09/01/06

27 Graham Avenue 14/12/04

27 Graham Avenue 19/04/04

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Insight - Eastchurch

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33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 27 Graham Avenue 27 Graham Avenue Brighton East Sussex BN1 8HA Lead Inspector Glynis McLeod Announced 18 July 2005 10:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 27 Graham Avenue Address 27 Graham Avenue Brighton East Sussex BN1 8HA 01273 503058 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hallcreed Limited Ms Kathleen Penney Care Home 4 Category(ies) of Learning Disability (LD) 4 registration, with number of places 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is four (4). 2. Service users must be aged between eighteen (18) and sixty-five (65) years on admission. 3. Service users with a learning disability only to be accommodated. Date of last inspection 14 December 2004 Brief Description of the Service: The home is situated in a pleasant residential area of Brighton close to local shops and pubs. It is convenient for bus services into Brighton and other areas, and Preston Park train station is also nearby. The building is a threestorey semi-detached property with large rooms and has a patio area with a barbecue in the long rear garden. Residents have the use of a large lounge, a kitchen/dining room and a music room. They also have the advantage of the use of a hydrotherapy pool at one of the other properties owned by Hallcreed Ltd. There is ample free parking in the road outside the home. 27 Graham Avenue is registered to accommodate up to four people with a learning disability; it does not provide nursing care. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection, which was announced, took place over five hours and was one of two inspections required over the year. A tour of the premises took place and records relating to care, medication and maintenance were inspected. The inspector spoke with the manager and met with all four of the residents as a group. The inspector would like to thank the residents and staff for their hospitality and co-operation during the inspection. What the service does well: What has improved since the last inspection? What they could do better: In order to ensure the safety and well-being of residents, the home needs to complete and review individual risk assessments more regularly. Care plans also need to be reviewed more regularly to make sure that any changes in the care of residents is recorded and acted upon. Risk assessments for hazardous 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 6 substances, such as cleaning materials, also need to be completed to ensure the safety of residents and staff. The information given to residents and families about how to make a complaint needs to be updated, and residents must be given a simplified version that they can understand. The adult protection and whistleblowing policies also need to be updated with information on how to contact the social services department and the Commission for Social Care, so that there is no delay in staff bringing problems to the attention of the proper agency. There are two outstanding requirements from the previous inspection that the home still has to attend to. The recruitment records for staff need to be kept at the home so that they can be inspected to make sure that the proper safety checks have been carried out, and the testing of all portable electrical appliances needs to be arranged as soon as possible to ensure their safety. 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. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 4 Clear and comprehensive written information about the home is available to prospective residents and their relatives, who also have the opportunity to visit and talk with the manager before moving in so that they are clear about the services offered. The home’s written procedures ensure that prospective residents are appropriately assessed. Consultation with other professionals and families ensures that a clear picture of residents’ needs and wishes is available before admission. EVIDENCE: The statement of purpose has recently been updated with details of new staff members and contains all the information required to enable people to make an informed choice about whether they wish to live in the home. It also contains a detailed assessment procedure to ensure that the home can meet the needs of prospective residents. A clear guide for service users has been produced in picture format, which gives residents all the information they need in a simple and understandable format. The home has a long-term group of residents and only one person has been admitted in the past six years. The moving-in process took place over many months and included day visits, and overnight and weekend stays at the home. A six-month settling-in period is offered to give the new resident and existing 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 9 residents the opportunity to get to know each other and ensure that the placement meets both the needs of the individual and the group. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 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 standard(s) 6,7 and 9 Care plans and risk assessments should be reviewed more regularly to ensure that residents’ changing needs are properly met. Staff are good at encouraging residents to make decisions and giving them opportunities to take control of their own lives. Staff also support residents to take responsible risks to enable them to live as independent a lifestyle as possible. EVIDENCE: Although individual care plans are completed for each resident, these are not reviewed six-monthly, as recommended, but yearly. There was also no evidence that risk assessments were reviewed regularly; some were dated 18 months previously. Yearly reviews mainly take place at the day centre with the residents, any family, and workers from the home and social services department present. To ensure that residents’ needs are fully identified and met, a requirement was made that risk assessments must be reviewed and updated regularly, and a recommendation was made that care plans should be reviewed six-monthly in line with good practice. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 11 Staff encourage residents to make decisions about their lives, such as choosing where they would like to go on holiday, or what activities they would like to do at the day centre or in the home. On a day-to-day basis, staff also assist residents to be as independent as possible by, for example, taking the bus into town and helping them to shop. The manager said she always encouraged residents to ‘have a go’ at activities, especially when new opportunities arose, such as when they were on holiday. Staff help residents develop social skills by example and repeated explanation, and teach them about personal safety by working with them individually. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 15 and 16 The residents are fully integrated into the life of the community, and many local amenities and facilities are accessed providing opportunities for recreation and stimulation that enhance their lives. Staff interact well with residents and respect their privacy and dignity. Residents are given daily opportunities to meet with different people and are encouraged to keep in contact with their friends and families. This enables them to develop life and social skills and to maintain important family relationships. EVIDENCE: All of the residents attend daycentres five days a week, participating in activities such as art and craft, gardening, dog walking, and dancing and music. The home encourages residents to attend clubs open to all people, not just those with disabilities, and helps them to actively engage in community life by taking them to the shops and cinema, pub lunches and fish and chip suppers. Residents also enjoy going to the pier and having car rides. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 13 Visitors are welcomed to the home and some residents also go to their families for weekend stays. One resident returned home from a weekend visit during the inspection and was warmly welcomed home by staff. Residents are encouraged to maintain friendships they develop at the day centres and other social clubs they attend. Staff were seen to treat residents in a friendly and courteous manner and to interact with them by means of words, gestures and signing. Residents were relaxed and confident about expressing their wishes by means of verbal and physical expressions. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 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 standard(s) 18, 19 and 20 Residents’ health, personal and emotional care needs are identified and their preferences are respected, enabling them to retain independence and control over their lives. Medication policies and procedures are clear and comprehensive, and regular monitoring of medication issues means that residents receive their prescribed medication correctly. EVIDENCE: From observation on the day, it was clear that residents were able to express their preferences for moving and handling and that staff respected their wishes. Personal care is given by staff of the same gender and residents are able to ask for help from any worker they feel comfortable with. Residents have access to a wide range of health services, including dentists, opticians and chiropodists, and staff support residents when attending these and other healthcare appointments. Medication policies and procedures were all in place and medicines were properly stored and secured. Records examined were all in order, and the manager and senior carer had attended medication-training courses. Since residents are unable to manage their own medication due to their condition, a recommendation was made that the home should try and get residents’ agreement for staff to administer their medication so that it is clear their consent has been obtained. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Residents’ concerns and wishes are listened to and staff make every attempt to meet their requests. The home’s complaints policy, however, is not produced in a format that residents can understand and does not contain all the required information. Adult protection policies and procedures are in place and give staff guidelines on how to ensure the safety and well-being of residents. EVIDENCE: The home has a complaints policy that needs to amended in order to fully meet the regulations. Details of timescales need to be included, as does the name, address and telephone number of the Commission. A version for residents must also be produced in a suitable format and given to, or explained to them. A requirement was made that the home must attend to the above issues. On a personal level, it was observed that staff do listen to residents’ wishes and try to ascertain how they feel about things by asking them to confirm their requests, and by the use of a ‘smiley/sad faces’ board. Since the last inspection, the manager has attended adult protection training and a senior carer is also due to attend the course. The manager had copies of the adult protection guidelines and was aware of local procedures. Detailed policies for dealing with verbal and physical aggression were in place and gave staff clear instructions on how to deal with any incidents to ensure their own and the resident’s safety. A recommendation was made that the adult protection and whistleblowing policies were updated with the current contact details of the social services department and the Commission. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 28 and 30 Residents live in comfortable, well-decorated surroundings and have access to all parts of the building and the garden. The home is safe, well-maintained, clean and hygienic. EVIDENCE: The home is comfortable, well-furnished and decorated. The property is wellmaintained and was in the process of being repainted outside at the time of the inspection. Residents are able to relax and watch TV in the sitting room, or play music in the music room. There is also a good-sized kitchen/diner. At the rear of the property is a patio area with a barbecue and a long garden. Residents also have the use of a hydrotherapy pool located in one of the other nearby homes owned by the company. Although one resident has mobility problems, they are able to access all areas of the building including the garden. The home is clean and hygienic and free from odour. There is no dedicated domestic team; care staff are responsible for keeping the home clean and tidy. The laundry is situated in the utility room and hand-washing facilities are available there, too. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 The home does not keep the recruitment records for staff members on the premises as required and it was therefore not possible to confirm that all the checks necessary to ensure the safety of residents had been completed. EVIDENCE: A requirement from the previous inspection that all staff records must be kept at the home and available for inspection had not been attended to. This requirement is carried forward. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The safety of residents and staff is not being fully safeguarded due to risk assessments for hazardous substances, for example, cleaning materials, not being completed and electrical appliances not being properly checked to ensure they are working safely. EVIDENCE: A requirement made at the previous inspection that testing of all portable appliances must be carried out by 28.2 2005 had not been attended to. The manager stated that she was in the process of arranging for the work to be done. This requirement is carried forward and must be treated as a matter of urgency. Although the home had some risk assessments for health and safety issues in place, a recommendation was made that risk assessments (COSHH) for all hazardous substances must be produced to ensure the safety of residents and staff. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x x 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 27 Graham Avenue Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 20 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. 2. Standard 6 22 Regulation 13(4)(c) 14(2) 22 (2)(5)(7) Requirement Risk assessments must be kept under regular review The complaints procedure must be updated to include all required information and an appropriate version must given to all service users. Recruitment records for each staff member employed must be kept at the home. (Requirement from previous inspection not met.) Risk assessments for all hazardous substances should be produced. A qualified electrician must carry out PAT testing on all appliances in the home. (Previous requirement date of 28.2.05 not met.) Timescale for action Immediate 30.9.05 3. 34 17(2) Schedule 4 13(4)(c) 23(2)(c) Immediate 4. 5. 42 42 31.8.05 31.8.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 6 Good Practice Recommendations Care plans should be reviewed six-monthly. H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 21 27 Graham Avenue 2. 3. 4. 20 23 Residents should be asked if they agree to staff administering their medication. The adult protection and whistleblowing policy should be updated with contact details of the social services department and the Commission. 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 27 Graham Avenue H59-H10 S14126 27 Graham Avenue V227166 180705 Stage 4.doc Version 1.30 Page 23 - 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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