CARE HOME ADULTS 18-65
Venner Avenue (40) 40 Venner Avenue Northwood Cowes Isle Of Wight PO31 8AG Lead Inspector
Christine Hemmens Key Unannounced Inspection 13th December 2006 10:00 Venner Avenue (40) DS0000012549.V315748.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 Venner Avenue (40) DS0000012549.V315748.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. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Venner Avenue (40) Address 40 Venner Avenue Northwood Cowes Isle Of Wight PO31 8AG 01983 293782 01983 293782 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) Islecare `97 Limited Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th September 2005 Brief Description of the Service: Venner Avenue is a small residential home for adults with learning disabilities and is part of the Isle Care Group of homes situated on the Isle of Wight. The home is a detached bungalow located in a quiet residential area of Northwood, within walking distance of local shops and the main bus route between Newport and Cowes. There are four single bedrooms for the service users and a communal lounge and dining/kitchen. Gardens are to the front and rear and are easily accessible by the residents. Parking is available on the front drive and the road at the front of the house. There is both level and ramped access to the front and level access at the rear. The service is part funded by social services and the primary care trust. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit to the home on the 13th December 2006 was undertaken over one day by one inspector. The inspector was assisted by the manager, deputy manager and staff. One resident was assisted to complete a comment card, however due to the residents cognitive and communication abilities the inspector observed responses through non-verbal communication and behaviours. A large part of this inspection was undertaken through observation and interactions between residents and staff. The inspector would like to thank the manager and residents for their hospitality. What the service does well:
The home does well to provide information about the home in the form of a Statement of Purpose detailing its environment, facilities and staff and management structure and skills. The manager does well to undertake a through assessment process on prospective residents. This is done with the assistance of others such as the resident’s representative, health care professionals and information obtained from the placing authority. The manager and his staff do well to ensure each resident has a personal plan that details the needs and how these must be supported. The plans have been developed using a person centred approach and provide a full picture of the residents history, personality, health and welfare and likes, dislikes and wishes and desires. The manager and staff do well to support the residents to take part in meaningful activites of their choice. The residents are supported to go on holiday, maintain family and friend contact and undertake leisure pursuits such as horse riding, swimming and going to the pub. The residents are provided with range of nutritious and wholesome foods. Detailed care plans advise the staff of what support the resident requires to eat and make choices and the home has access to specialist health care professionals such as a dietician if required. The home does very well to support residents with their health care needs, ensuring these are appropriately documented and treated and by referring any concerns to the appropriate specialist health care professional if required.
Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 6 The home does well to ensure the residents receive the correct medication at the correct time and dose by qualified staff. The home has good policies and procedures in place that are regularly audited by a senior member of staff. The manager does well to ensure each new member of staff undertakes training within the first six months of employment in adult protection and abuse awareness. This is a corporate course undertaken by a trained facilitator. Venner Avenue is a domestic style home providing a comfortable, clean and welcoming home for the residents to live. The manager does well to efficiently and effectively manage his staff team to meet the day-to-day need of the residents. The manager manages two homes and the staff team is currently working across both homes, however the manager is planning to change this in order to implant a keyworker system and continuity in both homes. The manager does well to ensure he has a skilled work force and ensures staff are fully inducted on starting, encouraged to undertake a national vocational qualification and is provided with specific training to meet the individual needs of the residents such as epilepsy, deathness awareness and autism to name but a few. The service has done well to appoint a manager who has sound values and is striving to improve the standard of care in the home. The manager demonstrates good leadership skills and is keen to ensure the residents needs are met through a person centred approach, however he is fully aware there is some way to go and further improvements to be made. The manager and staff do well to regularly undertake health and safety checks at the home, ensuring fire procedures are correctly followed and equipment fully serviced. The manager is mindful of his responsibility to seek the views of the residents and others involved in their care, and is hoping the new adapted quality assurance document will assist with this. The organisation carries out regular quality audits and seeks the views of staff through team meetings and individual staff supervisions. What has improved since the last inspection? What they could do better: Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 7 The home has developed good information in format of a Statement of Purpose, however the manager must ensure all information within the document is correct, such as ensuring the name of the regulatory body is that of the current one The Commission for Social Care Inspection and not the National Care Standards Commission. The home supports resident with limited verbal communication and therefore good do better to provide a communication friendly environment for the residents to live, to assist with making choices and decisions about the running of their home. The residents’ personal plans detail how the resident wishes to be supported and within this describes how the residents’ independence, dignity and privacy can be supported and respected. However the manager must ensure all his staff are aware of the personal plans and follow these consistently to avoid confusion and upset for the resident. The home does well to provide varied leisure pursuits, meals and supports residents to maintain relationships with family and friends, however the home must consider how theses areas of the residents lives can be improved upon, especially how residents are empowered and supported to make choices. The home must also consider the compatibility of residents to ensure individual behaviours do not affect the wellbeing of others. Through discussion with some staff including the manager and deputy manager the inspector established that they have a clear understanding of the needs of the residents in their care and promote a person centred and valuing approach, however this was not evident for all staff where the conduct of the staff member totally disregarded the individual choices, needs, wishes and desires of the residents. The manager must therefore address the concerns raised at the time of the visit and in the future immediately address staff performing in this way. The home has very good procedures in place for the administration of medication and care plans to detail the care and support the residents require, however it could do better to develop care plans for residents requiring “As required” medications, especially for those residents with non-verbal communication. The manager must ensure that all his staff are fully aware of the residents individual communication needs, be this through their vocalisations or behaviours. A failure to do this places the residents at risk of not have their views and expressed feelings heard and acted upon. The manager must therefore consider how to support residents to clearly say when they are unhappy or have a concern and must ensure vulnerable residents are not placed at risk of injury or harm by others. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 8 The manager provides a comfortable home for the residents to live, however he is advised to ensure staff receive training in infection control, brightens the lounge by introducing alternative lighting and chases up the engineers to repair the boiler as soon as possible. The manager with assistance of the organisation undertakes good procedures in advertising for staff, inviting them for an interview and issuing successful candidates with contracts, however it could not be evidenced at the time of the visit that all staff have undergone the appropriate checks that have been put in place to safeguard the residents from potential abuse. The organisation could do better to consider the managers current office facilities and provide him with appropriate space and equipment to undertake his role more efficiently and effectively. 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. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 9 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 Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 10 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 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has done well to up date its Statement of Purpose, however further work is required on it in relation to the attached complaints procedure, and the home could do better to produce a Service User Guide. The home adopts a person centred approach to assessing prospective residents needs. The service continues to fail to provide residents/ their representatives with a contract of their terms and conditions of residency. EVIDENCE: For the purpose of obtaining evidence for the above standards the inspector viewed records, documents and met with the manager and deputy manager. The home has recently revised its Statement of Purpose, which is provided to prospective residents and representatives prior to moving into the home. It provides information on the home’s environment, its management both organisational and local, staffing and facilities in which the resident can engage. However the attached complaints procedure requires revising to correct the name of the regulatory body from the National Care Standards
Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 11 Commission to the Commission for Social Care Inspection. This could potentially confuse anyone wishing to make a complaint about the service to the Commission. The home does not currently have a Service User Guide and is required to develop an accessible tool to meet the cognitive and sensory needs of the current residents and perspective residents. The inspector spoke at length with the manager and deputy manager on the process of assessment and the homes process for assessing and accepting emergency placements. The inspector viewed records for one resident that had recently been assessed using the organisations generic assessment tool. The assessment detailed their specific needs and the transition arrangements for them. The manager informed the inspector that they work very closely with the specialist health care teams and obtain information from other resources before making a decision if they can appropriately meet the prospective residents needs. This demonstrates that home takes seriously to need to ensure they can appropriately meet needs and that the resident is compatible with other residents living in the home. Following the last visit to the home the manager was issued with a requirement to ensure all residents are issued with a contract, stating their terms and conditions of residency. The inspector was informed that the contracts were in hand but to date the residents or their representatives had not received one. The requirement will be repeated with a tighter timescale for implementation, a further failure to comply may result in further action being taken. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 12 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does well to ensure each resident has a personal plan that reflects their assessed and changing needs, however further work is required in this area to support residents to be involved in the development of their plans. Staff must be guided to follow the plans. The home does its best to assist residents to make decisions. However the manager must ensure his staff respect those decisions and choices. The home undertakes thorough and detailed risk assessments. EVIDENCE: For the purpose of obtaining evidence for the above standards the inspector met with and observed interactions between residents and staff, viewed residents personal plans and met with the manager and deputy manager.
Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 13 The home has done very well to develop the resident’s plans using a person centred approach. The plans provide detail on specific areas of care including personal, physical, health and social activites and they are written as if the resident has written them their selves. The area of “my communication” is especially good and the inspector through reading this was able to gauge and interact with the resident. However the manager and staff must consider how the residents personal plans can be accessible for them, currently the plans are in large cumbersome files and are not all completed in an accessible format. The manager must consider how the service can empower the residents to have ownership of their plans and make them real. Ideas were discussed at the time of the visit and the manager agreed to consider how the service can address the issue and the difficulty of meeting the residents’ limited communication and sensory abilities. The residents personal plans detail how the residents must be supported and include the importance of making choices promoting independence and the values of dignity, privacy and respect. However the manager must address the concerns raised by the inspector at time of the inspection when it was clearly observed that a member of staff working in the home showed no respect or dignity towards a resident and clearly was not following the guidance in the residents personal plan to offer choices and promote independence. Sadly this behaviour undoes the positive work the manager and his deputy have undertaken. The home supports residents who have very limited verbal communication and who express themselves through their gestures and behaviours. The inspector found the home was not very “communication friendly” and provided limited information in an accessible format that the residents may understand, such as what staff are on duty, menu plan etc. The manager and deputy appeared aware of the need to improve this area of care. In three personal plans the inspector viewed there was evidence of good risk assessments, which includes the residents personal and physical wellbeing and social activities such as horse riding. The risk assessments detail the potential risk and how they it can be minimised. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 14 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): 12,13,15,16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does well to encourage and support residents to take part in peer and culturally appropriate activities, engage with their local community and undertake leisure pursuits of their choice. The home does well to support residents to maintain links with family and friends, however the home could do better to ensure vulnerable residents are not placed at risk by others. The home could do better to ensure resident’s rights are respected at all times. The home does well to provide wholesome well-balanced meals, however further work must be done with staff to ensure residents are offered choices. EVIDENCE: Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 15 For the purpose of obtaining evidence for the above standards the inspector viewed personal plans, observed activity in the home met with the manager and staff, viewed daily records. On the day of the visit the residents were attending day service activities, some of who returned at lunchtime. The resident’s personals plans and manager informed the inspector that the residents engage in a number of peer, social and leisure activities of their choice and liking, such as horse riding walks, swimming, going to town shopping and pub lunches etc. However the manager could do better to support residents to be more involved in the daily living activities such as food shopping. The residents recently went on a caravan holiday in the New Forest. The manager informed the inspector that it was a great success and everyone appeared to enjoy themselves. Photographs viewed by the inspector supported this. The manager and staff support the residents to maintain family contacts and develop relationships with others. The manager spoke of the close work they had been doing with a family to support the resident to move on and spoke of how the families are supported to be involved in the resident’s daily life. Family and friends are welcome to visit the home and the staff will support the residents to undertake visits when they wish. Through the assessment process the home will also test out the compatibility and vulnerability of prospective residents. However on the day of the visit the inspector witnessed a resident pull the hair of another several times, on viewing both resident plans it clearly stated that these two resident should not sit next to one another. Therefore the manager must ensure that at all times a proactive approach is used to prevent avoidable incidents and the guidance in the personal plans are followed as stated. The inspector had the opportunity to observe for approximately twenty minutes the interactions of a member staff with the residents on their return from day services. The actions of the member of staff caused concern and were discussed with the manager at the time. The member of staff showed no regard for the resident’s dignity and privacy, did not offer a choice of what to eat at lunch time, the residents lunch was “plonked” in front of them and then the member of staff whilst talking over the residents as if they weren’t there proceeded to tell the manager that they were going shopping without asking if any of the residents would like to join them and left with out saying good bye. This demonstration of very poor practice showed no regard or respect to the residents and the manager was required to address the concerns with the member of staff on their return. The home has a six weekly menu plan, which appears varied and well balanced. The likes and dislikes of the resident are clearly highlighted in their
Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 16 personal plans and there are detailed care plans on how to assist the resident to eat. However the home must consider how it can involve and empower the residents to make choices about what they would like to eat and how their food is presented to them. Such as picture menus, and ensuring liquidised meals are presented tastefully, foods individually liquidised to maintain colour and smell. The home has access to specialist service if required such as a dietician, however speech and language professionals are currently in short supply. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 17 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 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes care plans are very detailed, however it cannot be fully evidenced that these are correctly followed at all times. The home does well to meet the physical and emotional needs of service users. The home does well to retain, administer medications safely, however the home must ensure plans are in place for the administration of “as required” medications. EVIDENCE: For the purpose of obtaining evidence for the above standards the inspector, met with the manager and deputy manager, viewed residents personal records, observed staff interactions and viewed procedures for administering medication. As identified early in the report the home is in the process of adopting a person centred approach to meeting the holistic needs of the residents such as their personal, physical and emotional needs. These are clearly detailed in the
Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 18 resident’s notes and the manager, deputy manager and another member of staff confirmed through discussion that they are fully aware of the six core values of dignity, privacy, choice, independence, fulfilment and respect. However through observation the inspector was concerned that plans are not being correctly followed and cannot be fully evidenced that all staff are considering the needs and wishes of the resident. The home does well to have health action plans for all residents, these clearly detail all aspects of the residents health including medical history, allergies, immunisations, mobility, dental and women’s health to name but a few. The manager informed the inspector that the plans accompany the residents on appointments and the home has access to a number of health care professionals who will assist with assessment and implantation of treatment and writing guidance for staff. The home has very good systems for maintaining safe storage and administration of medication. The deputy manager whose responsibilities it is to monitor the policies and procedures assisted the inspector. The deputy manager demonstrated a very good understanding of the roles and responsibilities of staff administering medication and his responsibility in ensuring staff are carrying out correct procedures. There was evidence of the deputy carrying out regular checks and auditing stock levels. However the manager must ensure staff responsible for failing to carry out treatments such as topical creams and mouthwashes are addressed. Due to the complexities of the individual residents communication needs the manager must ensure care plans are in place to guide staff when a resident requires an “as required” medication (PRN) such as paracetamol, antipsychotic (Behaviour modifying medication), laxatives etc. The staff undertake a BTECH in safe handling of medication, which is a recognised qualification. The deputy informed the inspector that 50 of the staff had undertaken this course. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 19 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Due to the complexities of the resident’s communication they totally rely on the staff to consider their feelings, emotions and needs. As far as feasibly possible the residents are safe guarded from abuse, neglect and self harm, however the home must ensure vulnerable residents are not placed at risk by others and staff respect the holistic needs and wishes of the residents. The manager places residents at potential risk of harm by not undertaking robust recruitment procedures. This will be addressed in Standard 34. EVIDENCE: For the purpose of obtaining evidence for the above standards the inspector observed interactions between staff and residents, the behaviours of residents, met with the manager and deputy and viewed the complaints procedure and staff records. The home has a standard complaints procedure that details how and to who the complaint can be made. A copy of the complaints procedure was found in the resident’s personal plans. However the home must consider how it can support residents with complex communication and sensory difficulties to share their views and concerns and tailor the complaints procedure to each resident’s needs.
Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 20 Residents with limited communication were observed to express how they were feeling through behaviours, be that non-specific vocalisation, gestures, physical actions or submissively. Very good personal communication plans detail what these behaviours indicate and allowed the inspector to have a brief insight to the residents with whom she met. However through observation it was clear that for some staff they had either not read the plans or had no regard for what the resident was trying to say through these behaviours, placing the residents at risk of not having their needs met correctly and consistently. The inspector viewed very good behaviour intervention plans detailing the first signs of distress and the proactive approach required to assist them to clam, however the inspector observed a resident pulling the hair of another on several occasions when the plan clearly stated the residents in question should not sit next to each other. The manager must consider the vulnerability of others and ensure their safety at all times. The staff receive training in abuse awareness within the first six months of employment forming part of the induction process and is delivered by a trained facilitator within the organisation. Policies and procedures are in place and accessible for staff. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to provide a homely, comfortable and hygienically clean environment for the residents to live. EVIDENCE: For the purpose of obtaining evidence for the above standards the inspector toured the home, viewed records and observed practices. Venner Avenue is a domestic style bungalow set in a quiet residential area near Newport on the Isle of Wight. It has been adapted to meet the physical needs of the residents and each resident has a bedroom of their own. The communal rooms are domestic in size but comfortably accommodate the residents. The home was clean, tidy, tastefully decorated and welcoming. However some areas of the home especially the lounge would be benefit from alternative lighting as the room appeared gloomy and dark even during the day.
Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 22 The bathroom has an adapted bath and separate shower, however at the time of the inspection the home was without hot water and the residents did not have a choice of a bath and the heating was not working. The manager could evidence through records that he had reported the fault and that an engineer had called. The home was waiting for the engineer to return to make repairs. The manager was advised to keep onto them stating the urgency and needs of the residents whose personal hygiene could potentially suffer if not bathed frequently. The manager and staff promote the standards of providing a hygienically clean home. The staff were observed to follow good standards in hand washing, wearing protective clothing and disposing of clinical waste correctly. Notices were posted in areas where remembering to follow infection control procedures are important, although out of view of the residents. The home has adequate washing facilities, which can deal with heavy loads and soiled clothing and linen. However there was no evidence to suggest staff have received training in infection control, therefore the manager is advised to ensure staff receive this training. The manager must also consider replacing the handrail in the toilet, as this is wooden and absorbent for an easier to keep clean handrail. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 23 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 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager does well to provide sufficient numbers of qualified and competent staff to meet the needs of the residents. However the manager must undertake robust recruitment procedures to safe guard the residents from potential risk of harm. EVIDENCE: For the purpose of obtaining evidence for the above standards the inspector met with the manager, deputy manager, viewed the staffing rota, and staff records. The manager currently manages two homes within a couple of miles of one another, at the time of the visit the staff team were working across both homes and had been for a number of months. The manager described this as having its pros and cons but was currently reviewing the situation, with a view to reverting to two separate teams with deputies supporting each team and the manager.
Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 24 The manager and deputy demonstrated that they manage staff time affectively and efficiently. However the manager must be mindful not to allow staff to work excessive hours as this may result in fatigue and errors. Staff are encouraged and supported to undertake a national vocational qualification (NVQ) and at the time of the visit over 75 of the staff had achieved an NVQ. The deputy informed the inspector that he is currently undertaking an RMA and is hoping to go on to be a manager. This demonstrates the organisation offers a career path for its staff. For the purpose of ensuring the manager is appointing staff using robust recruitment procedures the inspector viewed personal files of the last two appointed staff. The inspector established through viewing the records that staff complete an application, attend an interview and receive a contract, however for one member of staff the manager could not provide evidence that identification had been obtained and a POVA and CRB check had been carried out before the member of staff commenced working. The manager was advised of the seriousness of not obtaining the appropriate checks and was advised further action would be taken in future, should recruitment procedures fail to improve. The service is proactive in ensuring staff receive a full induction covering all mandatory training such as fire safety, health and safety, food hygiene and first aid. In addition to this staff receive training specific to the needs of the residents. The manager informed the inspector of the homes future training plan such as autism, adult protection, deafness awareness, epilepsy guidance and sexuality. The manager is advised to ensure staff are aware of the core values of caring and revisit this regularly with his staff. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 25 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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager does his best to manage the home in the best interests of the residents, however a number of factors as described in the report have prevented the residents from having their needs fully met. The manager does his best to quality monitor and seek the views of the residents and staff. As far as feasibly possible the manager maintains a safe environment for the residents to live, EVIDENCE: Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 26 For the purpose of obtaining evidence for the above standards the inspector met with the manager, met the deputy manager and with a member of staff and viewed records. At the time of the visit the manager was waiting to undergo a Commission for Social Care Inspection registered managers interview. The manager has worked in the home for several months and is responsible for the management of another local home, he is supported by a deputy manager and senior staff. However it was evident at the time of the visit that the manager had not been able to implement all the good ideas he has for improving the service, and was in the process of making changes to the staff structure to have two separate designated staff teams. The manager spoke of some difficulties with staffing and how he had gone about moving staff on that were not appropriate to work with the residents, however it was still evident that this piece of work was on going. Through viewing the homes facilities it was felt the manager would benefit from a more space to carry out his day-to-day administration and a computer to speed up the time of developing and reviewing residents personal plans. The manager has two offices one in each home and the records for the staff are kept in the other home. The inspector visited the other home to view these and felt both offices require organising and when the designated staff teams have been decided their records must be kept in the home. The home is currently piloting a quality monitoring system to seek the views of the residents. This has been developed in picture and Makaton (Specific sign language for people with learning disabilities). The manager informed the inspector that due to the complexities of the resident’s disabilities and communication it challenges him and the staff to clearly establish the views and thoughts of the residents. However the home involves the resident’s family and friends. The home is quality monitored monthly by the organisations designated senior manager. Views of staff are obtained at staff meetings and individual supervisions. The manager as far as feasibly possible provides a safe place for the residents to live, there was evidence of regular checks being undertaken on fire safety equipment and systems and house hold utilities being serviced as required and the staff are mindful to keep corrosive substances hazardous to health (COSHH) out of reach of the residents. Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 1 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X 3 X Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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(1)(2) Requirement The registered manager must ensure each resident is provided with an accessible Service User Guide. Timescale for action 30/04/07 2 YA5 5(1)(c) The registered manager must ensure all residents or their representatives are issued with a contract stating the terms and conditions of residency. This requirement has been repeated. A further failure to comply may result in further action being taken. 31/03/07 3 YA7 YA16 12(2)(3) (4)(a)(b) 12(5)(b) The registered manager must ensure his staff at all times respectfully follow the guidance in the residents personal plans and ensure they are offered choices, treated with dignity and privacy and respect. 28/02/07 Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 29 4 YA15 YA23 13(6) The registered manger must ensure vulnerable residents are not placed at risk or harm from other residents living in the home. The registered manager must ensure residents with non-verbal communication have PRN medication guidelines in place. The registered manager must consider the individual needs of the residents and develop an accessible complaints procedure. The registered manager must ensure staff receive training in infection control. The registered manager must ensure all staff have undergone a POVA and CRB check before commencing work in the home. A failure to comply with this requirement will result in further action being taken. 28/02/07 5 OP20 13(2) 31/03/07 6 YA22 22(2) 30/04/07 7 YA30 18(2) 30/04/07 8 YA34 19(1) 28/02/07 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 YA6 Good Practice Recommendations The registered manager is advised to consider the communication and sensory needs of the residents when developing and involving the residents in the development
DS0000012549.V315748.R01.S.doc Version 5.2 Page 30 Venner Avenue (40) of their personal plans. 2 YA6 YA16 The registered manager is advised to consider the communication and sensory needs of the residents when promoting the resident’s choice, wishes, desires and independence. The registered manager is advised to install alternative lighting in the lounge. The service could do better to provide the manager with appropriate equipment and environment to carry out his day-to-day administration responsibilities. 3 YA24 4 YA37 Venner Avenue (40) DS0000012549.V315748.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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
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