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Inspection on 29/11/05 for 29 Briants Avenue

Also see our care home review for 29 Briants Avenue for more information

This inspection was carried out on 29th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This was a mostly positive inspection; residents were seen to be well cared for and happy. There appear good relationships between residents and staff. Staff support residents to participate in leisure resources in the local community and help them develop their potential. There are enough staff on duty to meet current needs. There is a system for assessing needs prior to admission. Staff are aware of residents needs and how to meet them. Care is reviewed involving residents, relatives and other professionals. Residents have homely accommodation, which is near to local facilities.

What has improved since the last inspection?

New carpets and a new patio have further improved the residents` environment.

What the care home could do better:

A corporate Health and Safety audit carried out in July found that some systems were out of date and some do not appear to have been addressed at the time of this inspection. A thermometer used to check hot water temperatures cannot give an accurate reading above 40% and needs replacing. CSCI will check with the Fire Safety Officer that the fire detection system in the home meets current standards. Residents money is kept in locked tins but these should be stored in a locked drawer or cupboard to improve security.

CARE HOME ADULTS 18-65 29 Briants Avenue Caversham Reading Berkshire RG4 5AY Lead Inspector Jill Chapman Unannounced Inspection 29th November 2005 15:10 DS0000011069.V263736.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 DS0000011069.V263736.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. DS0000011069.V263736.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 29 Briants Avenue Address Caversham Reading Berkshire RG4 5AY 0118 947 9795 0118 972 3479 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) The Disabilities Trust Ms Shanta Sharma Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000011069.V263736.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th June 2005 Brief Description of the Service: 29, Briants Avenue is part of The Disabilities Trust. The home provides a 24 hr service for people with Autistic Spectrum Disorder. Service Users are encouraged to overcome the disabling effects of their Autism and associated conditions, by participating in a variety of daytime activities and life experiences that promote and develop independence. DS0000011069.V263736.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out on a weekday afternoon over a period of two hours. The focus of the inspection was to follow up the requirements from the previous inspection and to inspect some of the key standards. Time was spent with the three residents and the member of staff on duty. The communal areas of the home were seen and records were sampled. The manager was not on duty and it was not possible to clarify some matters regarding health and safety. What the service does well: What has improved since the last inspection? New carpets and a new patio have further improved the residents’ environment. DS0000011069.V263736.R01.S.doc Version 5.0 Page 6 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. DS0000011069.V263736.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 DS0000011069.V263736.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): 2&4 The homes admission policy makes sure that they only admit residents whose needs can be met. EVIDENCE: There have been no new admissions to the home, however there is an admissions procedure in place. This was seen and includes an assessment to make sure the home can meet the needs of the new resident. The procedure also includes advice about pre placement visits. DS0000011069.V263736.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&7 Residents know that their care needs are reviewed to make sure they are met. The storage of resident’s money could be made more secure. EVIDENCE: In talking with a resident it was clear that care needs are assessed and reviewed. The resident described a review of her care and said that her parents and care manager also gave their views. The resident told how staff support her and meet her needs. Standard seven was not fully inspected but it was seen that resident’s money is kept in locked tins but these should be stored in a locked drawer or cupboard to improve security. DS0000011069.V263736.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): 12 & 14 Residents have the opportunity to develop their skills and independence through education and activities . EVIDENCE: Residents are supported to develop their skills and independence. On the day of the inspection, one said she had been to reading college for Art and Numeracy. She told of her part time job at a local supermarket. Two male residents had been to Henley College. One showed his artwork achieved that day. As well as formal activities or education, staff help residents to access leisure activities. These include in summer helping on the homes allotment and day trips and in winter Christmas shopping. DS0000011069.V263736.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): Not inspected on this visit. EVIDENCE: DS0000011069.V263736.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): Not inspected on this visit. EVIDENCE: DS0000011069.V263736.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 & 30 Residents’ benefit from homely accommodation, which is near to local facilities. It is kept clean to prevent infection. EVIDENCE: The home is situated in easy reach of the town centre of Reading and residents all can access this via public transport. The home is well cared for and homely. Since the last inspection new communal carpets have been laid and the garden patio has been replaced. The home is kept clean and hygienic. There are no specific hygiene needs however there is an infection control policy in place. The staff member was able to locate this and knew that this could be referred to if necessary. DS0000011069.V263736.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): 33 There are enough staff on duty to meet the current needs of the residents. EVIDENCE: During weekdays, the home is staffed from 7.30 am to 3pm by one or two staff depending on need. From 3pm to 10pm there is one staff and at night one staff sleeps in. It was seen that two staff were deployed during the morning of the inspection to enable two residents to attend college sessions. There is one full time staff vacancy, which is being covered by agency staff and overtime. Staff deployment appears to meet the current needs of the residents. It was clear from discussion with the staff member that she knows the residents’ needs and personalities well. Staff deployment takes into account the need to provide residents separate time and resources so that they all get enough attention from staff. Staff training takes into account the needs of the residents, for example Autism Awareness. DS0000011069.V263736.R01.S.doc Version 5.0 Page 15 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): 39 & 42 It is not clear whether there is a Quality Assurance System in place that helps residents give their views bout the service. Some improvements are needed to make sure that all health and safety systems are up to date. EVIDENCE: It was not possible to find out if the home meets standard 39. The member of staff on duty was not aware that a Quality Assurance System is in place. She was aware that the organisation sends an annual newsletter to parents. There were some health and safety matters that need clarifying or attention. A Health and Safety Audit was carried out by the organisation in July 2005. This highlighted the need to store hot water in the boiler at 45 to prevent Legionella. This conflicts with the risk assessments for each resident, which says that hot water outlets should be controlled at 43 to prevent scalding. DS0000011069.V263736.R01.S.doc Version 5.0 Page 16 For both needs to be met residents bath and shower outlets should have temperature control valves fitted. The Audit highlighted the need for a 24 hour First Aid cover and for all staff to have Food Hygiene updates. Training records supplied after the inspection show that the manager should to make sure that all staff have up to date First Aid and Food Hygiene training. The training record shows that staff had Fire safety training in 2003. This is significantly out of date; Fire Safety training should be carried out at least twice a year in line with guidance given by the Berkshire Fire and Rescue Service. The Audit highlighted that the Gas Safety Certificate has expired in 23/10/04. There was no evidence of a more recent one in place. Staff check water temperatures every week to make sure these are safe and prevent scalding. It was seen that the thermometer used does not give a specific reading over 40 . A suitable one should be purchased to make sure an accurate reading is recorded. It was seen that not all smoke detectors are connected to the fire alarm system. Advice will be sought from the Fire Safety Officer to make sure that the home meets current Fire safety standards. Only part of standard 43 was inspected and this is not met. The Audit highlighted that the Public Liability Insurance certificate on display is out of date. This has not yet been replaced. DS0000011069.V263736.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 x 3 x x x Standard No 22 23 Score x x 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 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 x 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x Standard No 37 38 39 40 41 42 43 Score x x 1 x x 1 1 DS0000011069.V263736.R01.S.doc Version 5.0 Page 18 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. 1. Standard YA42 Regulation 13(4)c Requirement Resident’s bath and/or shower outlets should have temperature control valves fitted. Timescale for action 28/02/06 2. YA42 13(4)c 23(4)d 13(4)c 25(2)e 13(4)c 23(4)d Provide written confirmation of 28/02/06 up to date training for all staff, in Food hygiene and First Aid. An up to date Gas Safety Certificate should be in place. An up to date Public Liability Insurance certificate should be displayed. Purchase a suitable thermometer for accurate checking of hot water temperatures. All staff should have Fire Safety training at least twice a year. 28/02/06 28/02/06 13/12/05 28/02/06 3 4 5 6 YA42 YA43 YA42 YA42 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 Good Practice Recommendations DS0000011069.V263736.R01.S.doc Version 5.0 Page 19 1 Standard YA7 Residents cash tins should be stored in a locked drawer or cupboard to improve security. DS0000011069.V263736.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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. 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