Inspection on 30/05/07 for 3 Hainault Avenue

This inspection was carried out on 30th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Hainault Avenue 02/01/06

3 Hainault Avenue 09/09/05

3 Hainault Avenue 06/03/05

3 Hainault Avenue 24/08/04

3 Hainault Avenue 23/03/04

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

CARE HOME ADULTS 18-65 Hainault Avenue (3) 3 Hainault Avenue Rochford Essex SS4 1UH Lead Inspector Mrs Bernadette Little Unannounced Inspection 30th May 2007 08:45 Hainault Avenue (3) DS0000018076.V335956.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 Hainault Avenue (3) DS0000018076.V335956.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. Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hainault Avenue (3) Address 3 Hainault Avenue Rochford Essex SS4 1UH 01702 545753 F/P 01702 545753 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Estuary Housing Association Limited Mr John Long Care Home 1 Category(ies) of Learning disability (1) registration, with number of places Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th September 2005 Brief Description of the Service: 3 Hainault Ave is a two-bedroom bungalow situated in a quiet residential area. Hainault Avenue provides one-to-one care for a service user who has a learning disability. The second bedroom is used as an office/ sleeping in room. The property is owned and managed by Estuary Housing Association. Shops and local amenities are within walking distance of the premises. The home has its own vehicle available to provide transport for accessing day centres and other leisure activities. The bungalow was furnished and decorated in a homely style. There is a large lounge and dining area. The conservatory leads out into the enclosed garden and was being used as a run for the rabbit. Parking is available to the front of the property. At the site visit, the manager advised that the current fees were £2583.72 per week. Additional charges payable by the resident include personal toiletries, chiropody and hairdressing, with additional information on this contained in the body of the report. Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection that took place over a four hour period on a Wednesday morning. The home had been informed of the inspection the evening before to ensure the availability of a member of staff, as it was known that the resident is regularly out in the community. The registered manager was on duty and he and the resident were spoken with and assisted with the inspection. A tour of the premises was undertaken and time was spent looking at records and documents. What the service does well: What has improved since the last inspection? What they could do better: The records that explain how the resident to be cared for, called the care plan, needs to be easier to read and better organised to help all staff, including occasional agency staff, to know how to best support the resident. The registered provider needs to make sure they do the necessary things to ensure the home is a safe place for the resident, such as the records to show that all agency staff have been checked as suitable to work at the home need to be in place before the person starts working there, or providing clear information on what the resident has to pay for, and visiting the home regularly to check out if it running well. Hainault Avenue (3) DS0000018076.V335956.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. Hainault Avenue (3) DS0000018076.V335956.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 Hainault Avenue (3) DS0000018076.V335956.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): 1, 2, 5 Quality in this outcome area is adequate. Residents are provided with a fair range of information, but it does need more detail and to be accurate so that the resident is fully informed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the statement of purpose and service user guide were seen on the resident’s file, and a pictorial form of contract was available in the resident’s bedroom. The contract explains that the service user guide has information about the fees. In one section of the service user guide it states that the cost includes items such as rehabilitation, social activities, food and furniture and equipment. In a later section it states that residents own, and therefore buy, their own bedroom furniture and any special equipment they need. There was no information on additional charges to the resident. Inspection of the residents financial records show that the resident regularly pays for their lunch at the centre each day and also for social activities including horse riding and the cinema. The home is run to meet the needs of one service user and there had been no new admissions of the last inspection. Estuarys policies, procedures and documentation confirmed a thorough pre-admission assessment process. Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. The resident was offered good individual care that needed to be better documented to ensure they receive this consistently and safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information was available about the residents care needs, but it was disorganised, in different files and not easy even for the manager to find when requested. The available care plans had not been reviewed since August 2005. It is acknowledged that the regular staff know the residents needs well, but a clear and accessible care plan is required that give staff detail on how to meet the residents care needs in practice on a daily basis. This is particularly necessary where agency staff are used as the one to one person supporting the resident. Risk assessments were in place that indicated that the resident is supported to take everyday risks, for example in using the kitchen, going out in the community or in activities such as horse riding. Other risk assessment documents needed more information including clear identification of the hazards and appropriate action is to be taken. Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 10 An annual review of the placement was booked to occur next month and would include the resident, an independent advocate, staff at the care home and the resident’s day resource placements. Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 11 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): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. The resident experiences an excellent level of individual life experiences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The resident has a planned activity sheet for each day. Records confirm that they are supported to access a range of activities, including attending day centres, working at a farm, gardening, going to the cinema or horse riding. Records indicated previous attendance at college courses and also staff supporting the resident to apply to access other work experiences. The resident is also supported to maintain family links and staff take the resident to visit their family regularly. A week’s holiday is also planned for the resident at Butlins later this year. The resident wrote their own daily report book, which confirmed the above activities and also that they attended church and liked this because people there spoke to them. Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 12 The record of meals served indicated a fair variety including the occasional take-away meal and included snacks and supper. The resident was prompted and supported to cook their own lunch, which they chose. The resident confirmed that they were having pork chops for dinner, which the staff member would cook for them and which they really liked. Discussion with the registered manager indicated that the resident’s right to exercise choice is respected and they are asked if they want to go to work each day, are given a choice of clothes within limits that they can cope with and a choice at each meal. These issues should be clearly documented in the detail of the care plan. Issues in relation to dignity were also discussed and this included prompting the resident to dress suitably when leaving the bathroom, or having staff knock on the bedroom door. Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 13 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): 18, 19, 20, 21 Quality in this outcome area is good. The resident’s health and personal support needs were met. Clearer records and protocols would better support consistency of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The resident was advised as able and supported to undertake their own personal care, with prompting and supervision, although this was not clearly recorded within the care plan. The resident explained that they had got up and had their wash and had their breakfast and were waiting to go out when the inspector left, as they wanted to go to work. Records confirmed that the resident had regular dental checkups, saw the GP and Practice Nurse as necessary and also had routine checks with their consultant psychologist. A risk assessment on the care plan confirmed that the resident was unable to manage their own medication. There were no omissions on the Medication Administration Records (MAR). A record of medications received was available as was an up-to-date medications directory. No sample signatory list of staff deemed competent to administer medication was available, and the manager Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 14 advised that this would not have included ‘one off’ agency staff. No protocols were available in relation to ‘ as required’ (PRN) medications. The registered manager advised that both he, and the other permanent member of staff, had undertaken updated medication administration training in the past year. No certificates of training/competence confirmed this for the permanent member of staff or for the occasional or ‘one off’ agency staff. Confirmation was provided of training in medication administration for the two permanent agency staff. Information regarding the residents view on end of life issues was recorded as recommended at the last inspection. Hainault Avenue (3) DS0000018076.V335956.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): 22, 23 Quality in this outcome area is good. The resident was supported to express their views. They were well safeguarded by policies and procedures and staff training on how to protect vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The commission had received no complaints regarding 3 Hainault Ave and the manager confirmed that no complaints had been received by the home. A pictorial format complaints procedure was clearly displayed. There was evidence that the manager, permanent staff member and two regular agency staff had attended training on protecting vulnerable adults. The manager was aware of appropriate procedures for reporting and protecting the resident. A policy and procedure on physical intervention was available and no incidents advised. There was no evidence that any staff except the registered manager had had any/or recent training in relation to managing behaviour those challenges/ positive responses. This was advised as a possible pertinent issue in relation to the residents care management if a staff member responded in a manner that was not appropriate to this individual resident. The last inspection report advised that a risk assessment on this issue may need to be considered. Hainault Avenue (3) DS0000018076.V335956.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): 24, 30 Quality in this outcome area is good. The premises fully met the resident’s needs and provided a homely and spacious living environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The bungalow was clean, warm, and comfortably furnished and decorated. The resident was seen to freely access all areas of the home. The residents had their own bedroom and ensuite toilet and wash basin. The bedroom door was fitted with a lock and the key was readily available to the resident. The room was personalised with trophies etc and the resident was keen to show their life size singing cardboard cut-out of Elvis. The shower room, the office and kitchen were locked during night-time hours. These were noted as an infringement of the resident’s rights, but could be better linked to clearer risk assessment and care plans and agreements sought from an advocate, if appropriate. A new front door had been fitted. A detailed risk assessment/management plan should be undertaken because of conflicting information regarding its safety. Hainault Avenue (3) DS0000018076.V335956.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): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. Residents are mostly supported by staff who are appropriately trained, and who they know. Residents are not well protected by the homes’ recruitment/training for non permanent agency staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was stated that the one permanent member of staff had achieved NVQ Level 3 although no certificate was noted on the file. The manager advised that none of the regular agency staff are undertaking NVQ training. Staffing levels were confirmed as one-to-one care at all times. There had been no permanent staff appointed for some time. Criminal Record Bureau checks were available for the manager and permanent staff, although the manager’s most recent check was over three years ago. Profiles confirming appropriate checks and references relating to the permanent agency staff were positively noted to be available. It was concerning to note that there were no recruitment records/profiles available for at least six other agency members of staff known to have worked in the home recently. The Responsible Individual at Estuary Housing Association was previously advised in writing of the Commissions concern Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 18 regarding this breach of regulation at a number of their registered facilities and assurances provided that the matter would be addressed. First day induction record sheets were seen to be available for agency staff including all those who had worked recently at the home. As noted previously, training records were not available for these agency staff. Training records for the permanent and regular agency staff demonstrated that staff had attended basic training in areas such as infection control, health and safety/fire, food hygiene, moving and handling, protection of vulnerable adults and basic first aid. Specialist training was also recorded for some staff including for example in relation to epilepsy and autism. The manager advised he did provide regular supervision to staff, including the regular agency staff. Recent records available showed supervision in October 2006 and again in March 2007. Supervision is mainly focused on planning activities for residents and the need to expand these to include areas of development were training for staff was discussed. Hainault Avenue (3) DS0000018076.V335956.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): 37, 39, 41, 42 Quality in this outcome area is good. The resident benefits from the individualised care and generally effective internal management. External management does not best protect the resident’s interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager continues to undertake NVQ level 4, Registered Managers Award. Records also showed recent training updates for example in relation to protecting vulnerable adults, food hygiene, health and safety and managing challenging behaviour. Areas for development include better management of the care recordings. Estuary do not currently provide a quality monitoring system at the home and have not undertaken the required monthly visits to, and reports on, the home since May 2006. Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 20 The registered manager advised that he endeavours to ensure quality monitoring by undertaking the safety audits for example in relation to fire equipment, safe water temperatures or vehicle checks. Records confirmed that these had been undertaken regularly. The record of fire drills only included the resident and the manager as they occurred at the same time each week. Advice was provided on ensuring that all staff were involved in routine fire drills. Current safety inspection certificates were available relating to the fire alarm, emergency lighting, gas and portable appliance testing. Accident records indicated that there had been no entries in the past year and the manager confirmed that there had been no accidents. Public liability insurance and the registration certificate were displayed. Records were available of resident’s weekly expenditure. Receipts are sent Estuary each week and therefore could not all be confirmed. The limited records/receipts sampled were acceptable and appropriately maintained. However there needs to be clarity in the charges made to residents and this has been previously discussed in the first section of this report. Hainault Avenue (3) DS0000018076.V335956.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 To` CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 2 33 3 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 4 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 2 X 2 X 3 2 X Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement The service user must be provided with full and accurate information in the service user guide on the fees and any additional charges. The service user’s plan must include information on all aspects of their health and wellbeing and be regularly reviewed to ensure consistent care is provided. This is an outstanding requirement. To protect residents, records must show that all the checks on all staff have be done to make sure they are safe people to care for residents. Residents must be cared for by suitably qualified and trained staff. This refers to training needs identified in the report and includes evidence of training for agency staff. Residents care outcomes and the conduct of the home generally must be checked monthly by DS0000018076.V335956.R01.S.doc Timescale for action 01/07/07 2. YA6 15(2) 01/07/07 3. YA34 17(2)Sch 4& 19 Sch 2 01/07/07 4. YA35YA23 YA20 18(1)a 01/07/07 5. YA39 26 01/07/07 Hainault Avenue (3) Version 5.2 Page 23 Estuary and the record of the visit available for inspection. 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 YA20 Good Practice Recommendations The registered person should ensure that written protocols or guidance are in place for medicines prescribed on a “when required” basis and that there is a list of the names, signatures and initials of staff deemed competent to administer medication to the resident. It is recommended that the whistle blowing procedure be developed to include a more user-friendly format. Staff should be provided with supervision six times annually and this should include issues such as training and development for staff. The registered manager should achieve NVQ level 4 Registered Managers Award. All should have opportunity to participate regularly in fire drills. 2. 3. YA23 YA36 4. 5. YA37 YA42 Hainault Avenue (3) DS0000018076.V335956.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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. 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