Inspection on 14/09/07 for 40 Venner Avenue

This inspection was carried out on 14th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

40 Venner Avenue 25/06/08

40 Venner Avenue 13/12/06

40 Venner Avenue 28/09/05

40 Venner Avenue 13/05/05

40 Venner Avenue 15/02/05

40 Venner Avenue 17/06/04

40 Venner Avenue 12/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 40 Venner Avenue Northwood Cowes Isle Of Wight PO31 8AG Lead Inspector Mark Sims Unannounced Inspection 14 September 2007 11:00 th 40 Venner Avenue DS0000012549.V342812.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 40 Venner Avenue DS0000012549.V342812.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. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 40 Venner Avenue Address Northwood Cowes Isle Of Wight PO31 8AG 01983 293782 F/P 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 Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2006 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. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a ‘Key Inspection’, which is part of the Commission for Social Care Inspection, regulatory programme and measures the service against the core and/or key National Minimum Standards. The fieldwork visits, the actual visits to the site of the service was conducted over two days and a total of 6.5 hours, as on arriving at the home on the first day the inspector was informed that it was the manager’s last day at work and despite being informed of the inspectors presents in the home, the departing manager opted to remain at Venner Avenue’s sister home. Therefore it was necessary to arrange a second visit to the home where in addition to the paperwork that required reviewing the inspector met with additional staff member’s and re-established contact with service users met during the original visit. The inspection process also involved far more pre fieldwork visit activity, with the inspector gathering information from a variety of sources: the Commission’s database, Questionnaires/Surveys, Annual Quality Assurance Assessment (AQAA) and dataset materials the latter two assessment tools completed and returned by the service provider. What the service does well: o Choice of Home: No one has been admitted to the home for over eighteen months. The last person to be admitted to the home was met during the fieldwork visit and it is acknowledged that they would appear to have settled well. The care manager for the resident has confirmed that an assessment was undertaken prior to admission; however, she feels some information was not effectively shared with the staff team, which lead to some early problems, although these appear to have been resolved. o o Lifestyle: The people living at the home are clearly involved in a range of day services that provide both educational and recreational activities. Personal and Healthcare Support: There is clear evidence with the service user plans that people are supported in accessing appropriate health care services and that their individual health action plans have been completed, with the intention of supporting people access services in a safe and comfortable/appropriate way. The service users medication was noted to be appropriately stored and the medication administration records accurately maintained. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 6 o Staffing: The staff were found to be friendly and knowledgeable about the needs of the service users. The staff team has also been boosted by the recruitment of two new staff members, although the loss of the manager has caused some concern. What has improved since the last inspection? o Choice of Home: The deputy manager was able to show the inspector copies of the contracts, which have been drafted and agreed with all relevant parties. Personal and Healthcare Support: The AQAA indicates that new PRN (as and when required) protocols have been produced and actioned following the last inspection. Staffing: The file of one new staff member was reviewed and found to contain all relevant checks and references, the second new employee has had her induction delayed, as the company are awaiting the receipt of her health check, which is evidence of their intention to operate as robust system. o o What they could do better: o Needs and Choices: The service provider has introduced a more ‘person centred’ care planning process, however, this is not being developed or maintained as changes in the persons, needs, abilities, aspirations, etc change and is still very much written in a task orientated style, with the author of the plans often substituting the third party for the first party, as a means of making the plan ‘person centred’. The staff confirmed that the plans are seldom referred too, as they are not truly reflective of the person’s needs, etc, they also confirmed that the person who produced the plans was brought into the home by the company and whilst they had some prior knowledge of the client and attempted to involve the key workers, much of this information is not encapsulated or included within the plans. o Complaints and Protection: The shortcomings of the ‘person centred’ plans extends into the realm of complaints and protection, as it gives little consideration to how the person might express concern or upset. Whilst the departing manager, has stated in the AQAA that the staff know and understand the service users, their abilities to recognise people’s changing moods or expressions are not adequately reflected within the ‘person centred’ planning programme. The plans also give little consideration as to how the person might require supporting when concerned about an issue or how staff should identify or resolve the problem, the plans focussing more on how ‘I might 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 7 express agitation or annoyance and how to placate me’, as apposed to determine the source of my complaint/concern/distress. o Environment: The internal environment is maintained to a reasonable standard, although this is thanks largely to the staff team and not the providers, the care staff having redecorated several rooms within the home, to save waiting for the company to sanction and undertake any redecorative work. The gardens on the other hand are just poorly maintained and over grown, the grass to the front and rear of the property is close to six inches high, the conifers in need of a hard cut and tidy up and a fence panel replacing because it is severely damaged. o Management: As mentioned day one of the fieldwork visit coincided with the last working day of the previous registered manager, which obviously leaves the home with no manager. However, what is more concerning is the apparent lack of support provided to the care services by the senior management, with the staff left for several weeks to ferry washing and/or drying to Venner Avenue’s sister home, Newport Road, as the broken machine was not repaired or replaced. The service users were left for several weeks without transport, as the lease car, which is leased from Islecare or Somerset Care the parent company, broke down and no replacement was supplied and the repair of the vehicle delayed. The management also seem unwilling to explore or sanction the replacement of the lease car, which is neither suited to it purpose, given its design and the complex health needs of the service users and its considerable age, most lease scheme’s replacing cars after three years. 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. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 8 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 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 2 & 5: Service users to use this service and their representatives have the information needed to choose the home. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: Pre-admission Assessment: The evidence indicates that people can expect to have their needs assessed prior to admission, although it is unclear if the information is being appropriately used. o As mentioned within the summary of the report no one has been admitted to the home for over eighteen months, which is not an unusual occurrence within a service for younger people. The last person to be admitted to the home was admitted as an emergency and this limited the time the home, staff and existing service users had to familiarise themselves with the new client. This factor could to some extent explain the early teething problems encountered, especially with regard to the persons’ health care, which 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 10 the care manager flags up as the most significant issue to have effected the persons’ admission. However, she also states that this was eventually resolved, which would be expected as the staff became familiar with the new service users needs, wish, aspirations, abilities and health and social care requirements. o During the first fieldwork visit the inspector met the person most recently admitted to the home and noted that the person appeared settled and comfortable within the home environment. Reacting positively to the staff and mixing well with other service users, although one-to-one interactions between the client group were limited. o Discussions with members of the staff team provided evidence of their awareness of the individual characters, needs and wishes of the service users. The inspector also observing the staff reacting to the prompts of residents, despite their often limited verbal communication skills, one service user keen to show the inspector photo’s an outing recently attended and a booking for the Circus, which is currently visiting the Island. Whilst the service user was unable to articulate their wish the care staff correctly interrupted their body language and general mannerisms and assisted the person to access the materials/items desired. Contract, Terms and Conditions: The evidence indicates that new terms and conditions contracts have been created for the service users and or their representatives’. o Following the last inspection the proprietary company were required to provided all service users and/or their relatives with access to updated terms and conditions documents. At the second fieldwork visit the deputy manager was able to produce copies of the new contract, terms and conditions documents however, these are unlikely to be of benefit to the service users, as they have extremely limited communication skills and in some cases impaired understanding. Some people also have very limited contact with their families or in some circumstances no known family members to support them with such matters. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 11 o However, all of the clients do have professional representation in the form of either solicitors or care managers and all of the clients have links to a Local Authority, as their placements have been arranged and are Local Authority Funded. The latter meaning the home is bound to a contract agreed with the Local Authority, which sets out for the provider the service and facilities they must provide as a minimum. 40 Venner Avenue DS0000012549.V342812.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 6, 7 and 9: Individuals are not sufficiently involved in making decisions about their lives, and play an inactive role in planning the care and support they receive. EVIDENCE: Care Planning: The evidence indicates that care plans are not well used and do not truly reflect the person’s needs, wishes, abilities, etc. The evidence used to make this judgement includes: o A review of three service user plans established that the company have introduced a new planning format, which is intended to place the client at the heart of the process. However, the review also highlighted that the plans are not being regularly reviewed and updated and that the information contained 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 13 within the plans does not truly reflect the needs, wishes and abilities of the service users. For example the information relating to one clients’ dietary preferences indicating that the person does not like to snack between meals, whilst the inspector’s observed the person eating biscuit’s, etc on returning from day services. The staff also felt that the information contained within the service user plans was incorrect and out of date. Citing several examples where the documented records and the person’s true wishes, abilities differed from those recorded. o The staff also stated that they seldom use/referred to the service user plans because of the inaccuracies within the documents and that generally they provided support to the client’s based on what they know about the person and how that person likes to lead their life. Many of the staff spoken with over the two-days are keyworkers, they are assigned greater responsibility for supporting a named client(s), with certain aspects of their day-to-day lives, shopping, attending health care appointments, etc, etc. However, during conversations, the staff stated that they had limited involvement in writing/preparing the current service user plans, this task completed by a third party who had previously worked at the home but who now had a different role within the company. Some of the staff did state that they had been spoken with as part of the process, however, the majority of the information used to generate the new service user plans was historic and taken/transferred from existing paperwork. The staff (keyworkers) also stated that they were seldom involved in service reviews and that this process was often completed by the management and professional staff. The lack of staff involvement in such processes, as the generation of the care plans and service reviews, etc, could account for the apathy shown by the staff when using the service user plans, it could also account for the inaccuracies and poor attention paid to reviewing the plans, as one of the central parties in the process, the keyworker is being excluded from the process, instead of given the responsibility for maintaining, updating and evolving the client’s plan. Decision-making: The evidence indicates that the service users are not always being appropriately supported when making decisions. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 14 o The evidence used to make this judgement includes: o The care planning process, referred to above, does not adequately reflect where, when and why some aspects of a person’s life might be or need to be subject to restrictions and/or limitations. For example, the plans do not adequately indicate why a client might be at risk of going out of the home independently or why they may require assistance/observations, etc with day-to-day activities such as sitting in the garden, two recent incidents’ involving people tipping out of garden seating and sustaining head injuries have risk assessments, which do not adequately indicate what can be done to minimise this occurring again in the future, i.e. consider new seating, etc. o In discussion with the staff the inadequacy associated with the lease vehicle, provided for the client’s by the company, were explored. This vehicle should not be considered fit for purpose, given the differing and often complicated physical health needs of the service users, the staff explaining how when taking client’s out, it is necessary to sit one client, who suffers seizures, in the middle of the back seat, as this is the only place the person can sit given the needs of the other service users. This situation greatly restricts/limits the staffs access to this person and has on occasion lead to the staff having to gain access to the client via the boot (the car is five door), as they cannot reach her by other means. If the vehicle were of a more appropriate size and design the client’s would be able to choose more suitable seating positions, which would promote access by the staff and safeguard their wellbeing. o The vehicle, provided by the company, also raises questions within this section of the report, based on how the service users are involved in decision-making around the leasing contract, the fee’s paid, the mileage costs, the frequency with which the vehicle is renewed, vehicle cover when the car is broken down, the home without a car for three weeks recently, whilst the existing vehicle was awaiting repairs. As lease car scheme’s go, the scheme being used by the company would appears to offering limited choice’s, benefits and/or alternative for the service users. o The relative comment cards also raise concerns around the staffs ability to support the service users with decisions, given the constant turnover of staff and manager’s, one person commenting in response to the question: ‘does the care service support people to live the life they DS0000012549.V342812.R01.S.doc Version 5.2 Page 15 40 Venner Avenue choose?’, stating: ‘ very rarely – staffing usually the reason given – not enough staff, not enough drivers, not enough funding’. o However, observations from both fieldwork visits established that the staff are keen for the service users to make independent decisions and that were possible they support people in making choices on what they wish to do, eat and drink, wear, etc. The staff also discussed taking people shopping and supporting them to choose clothes that they like, although there seems to be a expectation from the management that people should shop wisely, i.e. opt to purchase clothes from cheaper retailers to reduce expenditure, clearly the purpose of shopping for your own clothing is that you buy what you like from where you like at the price you like. Lifestyle and risk taking: The evidence indicates that people are not being appropriately supported to live the life they would choose. The evidence used to make this judgement includes: o Feedback from the relative comment cards, was mixed, with some people indicating that the service does support people to live the life they choose, whilst other’s felt there were obstacles, staffing, funding, etc which could restricted people’s opportunities to live the life they would wish. Professional comments also raise concerns with people’s abilities and/or opportunities to live their lives according to their own lifestyle choices due to staffing concerns: ‘lack of staffing can mean a lack of access to community facilities - on top of residential provision we provide 5 days per week day care and 2 - 4 hrs per week 1;1 time to combat this’. The observations / concerns of both the relatives and professionals, supported by the findings of the inspector during the first fieldwork visit, when only one staff member was on duty and in order to collect or pick up other clients’ from their day centre’s, etc she had to ring Venner Avenue’s sister home to organise staff cover. The impact of having only a single carer on duty being that the service users cannot go out to social events or local amenities and therefore their lifestyle is being restricted. o The inspector also noticed that the white notice board, used by the staff for communication purposes, indicated that two client’s, were down for 1 to 1 support hour’s that day, however their daily records indicate that the client’s went out for a drive together which is a 2 to 1 situation and not 1 to 1. DS0000012549.V342812.R01.S.doc Version 5.2 Page 16 o 40 Venner Avenue Clearly given the professional comment’s, reflected above, the local authority are paying for 1 to 1 hour’s, which is design to support people to live and enjoy their life as they wish. The service provider should therefore seek clarification from the local authority on who they are being paid additional monies to support and what is constituted/meant by 1 to 1 hours and what they are expected to provide. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16 and 17: People who use the service are able to make some choices about their lifestyle, although this is limited and are supported to develop life skills. EVIDENCE: Activities: The evidence indicates that the activities and entertainments undertaken by the service users do not always meet their specific needs and wishes. The evidence used to make this judgement includes: o Comments taken from conversations with staff, which establish that the lease car was out of action for three weeks, which resulted in disruption to the service users social lives and impeded their abilities to go and/or get out to social events of community based activities. DS0000012549.V342812.R01.S.doc Version 5.2 Page 18 40 Venner Avenue o Comments provided by relative and professional sources, which indicate that the lack of staff and/or the high turnover of staff and management, has a direct impact on the lives of the service users and their abilities to lead the lives they would like. Observations, which on day one of the fieldwork visits established that their was only one carer on duty, which would be inadequate to take people out in the evening or to social events, etc. When the staffing complement is correct, it is clear that people can go out, as two service users had been out to Ryde during the morning of the first fieldwork visit and during the second visit a client was taken out to a local park. The staff also discussed shopping trips, holidays and general outings to local attractions and venues, which further support the assumption that when sufficient staff are provided people can enjoy a more fulfilling life. o o Community Contacts: The evidence indicates that the people living at the home have limited access to community services. The evidence used to make this judgement includes: o The AQAA states that efforts have been made to integrate the client’s into the community more this year, with the manager approaching the local village community group and taking on the care and management of a local flowerbed. However, in discussions with staff it was apparent that whilst the service users and staff had started of with good intentions, their involvement in maintaining the local flowerbed had waned and they had not recently visited the bed to maintain it. o The service user plans and the noticed board within the kitchen do provide some indication of the service that people are involved in both day services and additional weekend activities groups, drama, etc. However, the inspector remains concerned over the reliability of the aging lease car and the continued threat of disruption to the residents social activities and community involvement, caused by vehicle breakdowns, etc. It is also interesting to note that as part of the plans for future development of the service the out going manager has included within the AQAA the need to develop the range of activities that residents can access. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 19 o Relationships: The evidence indicates that people are maintaining good relations with families and friends where possible. The evidence used to make this judgement includes: o The return of three relative comment cards indicate that people are involved with their families, although the comment cards do not give an indication of the extent of this involvement. From talking to the staff it was clear that people’s family relationships differ from person to person, with some people have regular contact with their family, whilst other people have a more distant relationship. What the relative comment cards to indicate is that people generally people feel their next-of-kin is supported in keeping in touch, with people stating that they receive birthday and Christmas cards, etc and that staff ring to keep them abreast of developments within the persons’ life, etc. o The AQAA also states quiet clearly that efforts are made to promote contact with relatives and friends, with people/visitors welcome at the home at anytime. It was also noted that some service users rooms contain photo’s of family member’s etc, these mementoes are useful reminders of people that are significant in a persons’ life. o Rights and Responsibilities: The evidence indicates that the rights of the service users are both understood and promoted by the staff. The evidence used to make this judgement includes: o Observations established that the service users are largely left by the staff to undertake activities of a self-directed/determined nature when in the home, people observed going back and fore to their bedrooms, going out into the garden, watching television within the lounge or sitting in the kitchen with the staff and other service users consuming snacks and drinking, etc. In discussions with the staff it was understood that there are not real set routines within the home and that the service users are supported to keep their rooms tidy and to participate in some household activities, washing up, tidying away after meals, etc. The service users were also noted to dress in accordance with their individualised styles, although, as mentioned earlier some of the staff feel the need to direct residents’ to less expensive stores to purchase o o 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 20 clothing, when in fact people should be able to spend their money as they see fit and without restrain or restriction. o The lack of staff however, remains a concern for both professional and relative’s to complete comment cards, one persons remarks summing up the central theme: ‘staff changes cause a lack of continuity – staff do not appear to have sufficient training or knowledge’. Meals and Menu’s: The evidence indicates that people enjoy meals that are based on their preferences and are varied and well balanced. The evidence used to make this judgement includes: o During the fieldwork visit the inspector observed people eating snacks staff preparing the evening meal, which was the main meal of the day and included nutritious and appetising ingredients. Observation undertaken within the kitchen, indicated that it is the central hub of the home, with both service users and staff using it to congregate and socialise after a busy day at their various services. Presently there is no menu, or no menu the service users could effectively interpret or understand, although plans are in hand according to the AQAA to create a pictorial menu. In the meantime the staff rely on their awareness and understanding of the service users likes and dislikes when preparing meals, etc. In conversation the staff stated that the service users occasionally enjoy a takeaway meal, chips, Chinese, etc, although these are not everyday occurrences, as they can be expensive. o o o 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 and 20: The health and personal care that people receive is based on their individual needs. EVIDENCE: Personal Care: The evidence indicates that the service users receive support with their personal care that meets their individual needs and wishes. The evidence used to make this judgement includes: o Observations from both the fieldwork visit days indicate that staff are sensitive to issues of respect and dignity when assisting service users with personal care issues, people observed escorting and/or assisting service users to the toilet in a straightforward no fuss manner, which prevents drawing attention to where someone is going. The service user plans, whilst still requiring a little work, as mentioned earlier in the report, do make reference to how a person like’s to receive support with aspects of their personal care, although this is still written DS0000012549.V342812.R01.S.doc Version 5.2 Page 22 o 40 Venner Avenue in a style that is task orientated, I like assistants with or I need this done for me, as apposed to a truly client centred approach which focuses on areas of support, I can complete actions AB&C and am learning how to manage EF&G so will require some support, guidance and prompting, etc. o The relative comment cards are a little mixed with two people indicating that the feel the care provided is good, on person remarking ‘they give love, care and kindness above and beyond the call of duty’, whilst the third person feels the lack either the skills or knowledge to support people effectively. Given the poor staffing situation faced at the home from time to time, as highlighted during the first fieldwork visit when only one care was on duty and the inability of the company to recruit and retain a permanent manager, it is likely that there are occasions when the care and support required is less than satisfactory. However, the staff members, met on both fieldwork visit days, demonstrated a good knowledge of the service users needs and abilities and were clearly aware of what people like and or wanted, which indicates they were attuned, from a communication perspective, to the persons’ needs. Health and Emotional care needs: The evidence indicates that the health care needs of the service users are not always being appropriately identified, addressed or monitored. The evidence used to make this judgement includes: o The service user plans were noted to contain detailed information about people’s medical histories and health action plans, which identified the individuals preferences with regards to their health care and where they feel most comfortable receiving care. Professional comments indicate that problems have been encountered with the monitoring of service users health care needs, especially during the early days of the persons’ stay at the home. The professional comment cards also indicates that following meeting’s, etc, with the staff teams and management these problems were addressed and mainly appeared to be communication difficulties with the management not cascading important information down to the staff team. o The AQAA indicates that the service users are involved with appropriate health and social care services and that this year the manager has DS0000012549.V342812.R01.S.doc Version 5.2 Page 23 o 40 Venner Avenue arranged for each female resident to undergo a ‘well woman’ assessment at the local medical centre. o However, the earlier concerns expressed by staff, in respect of accessing client’s whilst travelling within the lease car, make it clear that the health and wellbeing of the service users is not being appropriately taken into consideration by the management or the company and action must be taken to review the current situation and suitability of the lease car given people’s health a physical care needs. Medication: The evidence indicates that service users are appropriately supported in managing their medication. The evidence used to make this judgement includes: o o o Observations established that the home’s medication storage facilities are appropriate/satisfactory. The medication administration records (mar) inspected were appropriately and satisfactorily maintained. The AQAA indicates that a medication procedure is made available to staff and that staff receive training before being allowed to dispense and administer medications. The Commission’s databases were checked and no reports of medication errors occurring at the home have been received. o 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 22 and 23: People who use the service are unable to express their concerns and have to rely on relatives, visitors and staff to support them access the complaints procedure and ensure they are protected from abuse. EVIDENCE: Complaints and Concerns: The evidence indicates that service users are able to express concern and unhappiness but have communication difficulties that would prevent them from using a complaints process unsupported. The evidence used to make this judgement includes: o Observations allowed the inspector to both witness people expressing how they felt vocally and physically and to consider the staff’s responses to these communication cues. Generally the inspector noted no problems with either the staff’s abilities to interpret the persons’ expressions or their response to the situation, which were prompt and appropriate. However, with the concerns over staffing levels, staff turnover and the loss of the registered manager, all of which have been addressed earlier in the report, there is a skill drainage and a pressure placed upon the staff, which could cause potential problems when addressing or 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 25 managing people’s unhappiness or their right to vent their anger at situations. o The relative comment cards indicate that people have used the home’s complaints process to raise concerns and that on occasions the complaint has lead to meetings with key parties and the issues being resolved jointly. However, one of the relatives seems concerned, now that the manager has left, with whether or not any good work or agreements reach, etc will be adhered to, which is a valid concern and something the company management should monitor. o The AQAA indicates that staff receive training on the use of the home’s complaints process and procedure, however, in talking with staff it is unclear/uncertain if they feel the company management are interested in complaints raised on the service users behalf, the unreliable car, staff shortages, issues with decoration and maintenance all being issues raised with the company on the service users behalf and which remain unresolved. The dataset further establishes the existence of the home’s complaints and concerns procedure, although again this provides no indication of when the document was last reviewed or updated. The dataset also contains details of the home’s complaints activity over the last twelve months: 1. 2. 3. 4. 5. No of complaints: 0. No of complaints substantiated: 0. No of complaints partially substantiated: 0. Percentage of complaints responded to within 28 days: N/A. No of complaints pending an outcome: 0. o o Safeguarding Adults: The evidence indicates that the service users’ welfare is promoted and that the management and/or staff seek to protect people from abuse and harm by their practices. The evidence used to make this judgement includes: o The Commission’s database’s evidence that five adult protection referral has been made since the last inspection and that these have been successfully resolved. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 26 o The AQAA/Dataset also provides evidence that the company has an adult protection strategy, which was last updated in 2006 and that staff are receiving appropriate ‘safeguard people training’. Observations indicate that the people living at the home appear generally happy and content and conversations with staff have established that whilst sometimes people can become a little irritable, etc, episodes of an aggressive nature are largely diminishing and that risk assessments and guidance information is in place. o 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 24 and 30: The physical design and layout of the home enables people who use the service to live in a safe and comfortable environment, which encourages independence. However, the reasonable decorative condition of the house is thanks to the staff and the grounds require attention, as they are overgrown and showing signs of wear and tear. EVIDENCE: Environment: The evidence indicates that the service users are living within a reasonably well-maintained environment. However, further improvements could be made to the home with the gardens/grounds requiring attention and if the redecoration of the home was undertaken by the estates team and not the care staff. The evidence used to make this judgement includes: 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 28 o Observations, which on arrival at the home established that the front garden required attention, a conifer hedge left to grow wildly and unchecked and the grass above ankle height. To the rear the grass again was reaching ankle height, a damaged fencing panel, which has been reported to the company, is awaiting replacement, shrubs are overgrown and the remains of a shrub that had been pruned left outside of the patio doors to rot down. o In conversations with the staff it was established that the main lounge and hallway have recently been decorated, however, as it take so long for the company’s estates team to attend to such jobs, the staff had purchased the paint and redecorated the rooms themselves, some finishing touches (pictures, etc), were still waiting to be added to the lounge. The AQAA makes clear that the outgoing manager would like to soften the décor within the home, (hence the work undertaken by the staff), as he feels currently the decorative condition of the home makes the environment feel institutional and he would like the premise to feel like a home rather than a care home. A tour of the premise established that generally the interior of the home is up together and that the service users bedrooms have been individually decorated and set out, with personal items used to denote/reflect the uniqueness of the characters occupying each room. Feedback from both professional and relative sources, indicate that the environment is not a major concern or problem, one person did commenting that home was perhaps a little small, however the majority of people feel its size adds to the homely and friendly atmosphere created within Venner Avenue. o o o Cleanliness: The evidence indicates that the home is generally clean, tidy and free from odours. The evidence used to make this judgement includes: o The tour of the premise raised no concerns with regards to the cleanliness of the home, staff undertaking the majority of the cleaning, when the premise is quiet and the service users out at day services. In conversation with the staff, they confirmed that the service users are encouraged to help in keeping the home tidy and safe for all parties, however, the level of the persons’ involvement in this process is determined by both their physical abilities and levels of comprehension. o 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 29 o The dataset establishes that the staff have access to infection control guidelines and that these policy documents were last reviewed in the February of 2007. The AQAA establishes that training is provided to staff around health and hygiene and that following the last ‘Environmental Health’ visit the home was awarded a five star rating. o 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 30 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 32, 34 and 35: Staff in the home are trained and skilled but supplied in insufficient numbers to support the people who use the service. EVIDENCE: Training & Responsibility: The evidence indicates that the training opportunities for the staff are good. The evidence used to make this judgement includes: o The AQAA and Dataset indicate that the home provides a comprehensive induction programme for staff, a statement confirmed by training records/schedules, which include dates for induction into the company and observations, which established that dates for the induction into the home environment had been allocated for two new staff, this information taken from the notice board within the kitchen. In discussion with the permanent staff member, it was ascertained that training opportunities are good and that ‘Islecare’, arrange and provide DS0000012549.V342812.R01.S.doc Version 5.2 Page 31 o 40 Venner Avenue staff with access to a variety of educational events, including the appointed persons training’, this includes first aid and other skills elements required before a person can be left in charge of the home. o The Dataset, also indicates that the home/service is registered with ‘Skills for Care’, the sector skills training council, who monitor and approve all courses undertaken. Information taken from the dataset and confirmed during the visit, indicates` that currently the home employs 5 care staff. 3 of 5 care staff have completed a National Vocational Qualification (NVQ) at level 2 or equivalent, giving the home a percentage of 60 of its care staff possessing an NVQ at level 2. o The dataset also indicates that 2 care staff are presently completing an NVQ level 2, which, should the carers pass the course, could raise the home’s percentage rate to 100 on the current staff ratios. o Recruitment and Selection: The evidence indicates that the recruitment and selection process of the company is well structured, however the home is experiencing difficulties in attracting and retaining staff. The evidence used to make this judgement includes: o Evidence has been included within the report, which demonstrates that the home is experience staffing difficulties, one carer on duty on the inspectors arrival, the loss of the manager, comments and observation provided by relatives, professionals and staff. The manager, via the AQAA does state: ‘retention has been better than in previous years’, however he himself has left, which has concerned families, one family member stating ‘the current manager seems to have made a few positive changes, when he leaves I worry about the legacy for the residents’. The recruitment of two new staff will help the situation at the home and will increase the staffing levels/compliment back towards being fully staffed, with the exception of the manager’s position. The staff files of one of the two people to be recruited was available for inspection, the second file not available as the person’s reference and/or checks had not yet been completed and her employment not commencing until all required information is returned. The file inspected was found to contain all of the required information, a completed application with full employment history, two references, 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 32 o o health declaration, ‘Criminal Records Bureau’ and Protection Of Vulnerable Adults’ checks and supporting documentation. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 33 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards: 37, 39 and 42: The manager and staff have made the best use of resources available to deliver a reasonable quality service to the resident’s. EVIDENCE: Management: The evidence indicates that the manager and staff could be better supported by the company; as currently the service is failing to provide the care and support required by the residents. The evidence used to make this judgement includes: o The lease car breakdown, which was not resolved for three weeks and no replacement vehicle was provided, which resulted in the service users ability to socialise being compromised. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 34 o The replacement of the lease car, which is neither suited to it purpose, given its design and the complex health needs of the service users and its considerable age. The redecoration of the both the lounge and hallway, which was undertaken by staff due to problems/delays in getting the work completed by the estates department. The maintenance of the gardens and replacement of a damaged fencing panel, which has been reported, the inspector having seen the correspondence; but which remains an outstanding issue. The broken washer and/or drier, which resulted in clothing being transport to Newport Road, the sister home of Venner Avenue, for laundering. Regulation 26 reports, that are not being carried out or the reports not provided to the manager following the visits to the home, regulation 26 very clear about monthly visits being undertaken and reports produced. The home is currently, also without a registered manager, given the resignation of the previous manager, which has caused concern for relatives, as mentioned within the report and could have an impact on the service users if not resolved quickly. o o o o o Quality Assurance: The evidence indicates that people are being involved in monitoring the service and the care provided where possible. The evidence used to make this judgement includes: o The care staff confirmed during conversations that regular reviews of the service users needs are undertaken, although the evidence on reviewing the care plans is that this information is not appropriately included/reflected within the service user plans. Professional comments also support the view that peoples’ care/support needs are being regularly reviewed and updated and summaries of these reviews produced and forwarded to the service. The company are known, historically, to have a good quality auditing system, which includes arranging for the manager’s to measure the service against the standards and to seek feedback from staff, etc on the service being provided. However, due to the manager having left the service on the day the first fieldwork visit occurred the effectiveness of this system could not be checked. 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 35 o o o As mentioned above their was evidence to support the fact that the company are not carrying out regulation 26 visits as required and/or not producing the required reports. Health and Safety: The evidence indicates that the health and safety of the service users and staff is being appropriately managed. o o No immediate health and safety concerns were identified with regards to the fabric of the premises during the tour of the premises. The dataset and AQAA establish that full health and safety policies/guidance documents are made available to the staff and that equipment is regularly maintained and serviced, gas, electrical installations, portable electrical appliances, etc, etc. Health and safety training is clearly made available to staff, with the care staff providing testimony of the training completed and the dataset evidencing that staff have completed such courses as, food hygiene, etc. o 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 36 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 X 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 3 X X 3 X 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 37 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 YA6 Regulation Regulation 15. Requirement The service users plans should be regularly reviewed and updated and should reflect both the current aspirations of the service users and the support required to achieve those aims and objectives. The service users plans should also be working tools and the staff should feel confident enough in the information provided to use the plans during their day-to-day contact and support of the residents. The company should make arrangements to discuss with the service users and their representatives how they can best be supported when DS0000012549.V342812.R01.S.doc Timescale for action 24/10/07 2. YA7 YA12 YA19 Regulation 12. 24/12/07 40 Venner Avenue Version 5.2 Page 38 making decisions, around such complicated issues as a lease car scheme, which is likely to meet both their needs as younger adults and people with both physical and educational disabilities. The lease car should be reviewed with the above parties, taking into account people’s right’s not to be stranded and/or socially isolated should the car breakdown. The particular health care needs of the client’s and how staff can gain quick and appropriate access to people in emergency/urgent situations. The proprietary company must take steps to ensure that all new staff employed within the home are appropriately supported/inducted into the home environment. The management must also ensure that a detailed description of how a client shows displeasure an/or upset, etc is included 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 39 3. YA22 Regulation 22. 24/10/07 4. YA24 YA37 Regulation 23. within the service user plan, along with details of how the staff should be assisting/supporting a client to manage their feelings and seek a satisfactory resolution. The management must make arrangements for the gardens to be adequately maintained and for repairs and damage to be addressed within a reasonable timescale. The company management must also review its estates strategy, so as redecoration does not have to be done by care staff in order to maintain and/or create a homely and well-kept environment. The company management must also review any/all service level contracts, as it is unacceptable and unhygienic for a home to be without an appropriately operating laundry facility. 24/12/07 5. YA34 Regulation 18. The company management must ensure that at all times appropriate DS0000012549.V342812.R01.S.doc 24/12/07 40 Venner Avenue Version 5.2 Page 40 and adequate staffing levels are maintained within the home. Staff should not be required to ask sister establishments or off duty staff to staff the home, whilst other duties/tasks are undertaken. The company management must provide adequate support and resources to the registered manager to ensure the satisfactory running of the home and the safety and wellbeing of the service users. The company management and the registered manager must seek to resolve issues within a timely fashion and not delay at the expense of the service provided to the residents, i.e. replace broken or damaged equipment, address issues of maintenance and décor, review the lease car scheme and its suitability based on the heath and physical support needs of the current client group. 6. YA37 Regulation 10. 24/12/07 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 41 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 YA9 Good Practice Recommendations The service user plans and risk assessments should clearly reflect where and why a limitation has been placed on an activity and these should be regularly reviewed and updated. Where accidents occur details of the management options considered should be recorded on the risk assessment, i.e. falls from a garden chair – possible management options: closer observations of service users, review and improve how the equipment is secured or replacement of furniture if unsuitable, etc. If the management believe people can become better integrated into the community by undertaking community based scheme’s i.e. maintaining local flowerbeds, etc. It is important to ensure that these activities are kept up with, as a failure to do so could result in the opposite reaction being achieved. 2. YA13 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 42 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 © 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 40 Venner Avenue DS0000012549.V342812.R01.S.doc Version 5.2 Page 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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