Inspection on 11/09/07 for 43, Florence Avenue

This inspection was carried out on 11th September 2007.

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

The inspector found 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

43, Florence Avenue 15/05/08

43, Florence Avenue 26/06/06

43, Florence Avenue 28/11/05

43, Florence Avenue 24/05/05

43, Florence Avenue 22/11/04

43, Florence Avenue 27/04/04

43, Florence Avenue 21/10/03

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 43, Florence Avenue Morden Surrey SM4 6EX Lead Inspector Jean Stuart Unannounced Inspection 11th September 2007 10:20 43, Florence Avenue DS0000027216.V349116.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 43, Florence Avenue DS0000027216.V349116.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. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 43, Florence Avenue Address Morden Surrey SM4 6EX 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) 0208 646 5921 www.caremanagementgroup.com Care Management Group Ltd Beverley Knapp Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 8 5th July 2007 Date of last inspection Brief Description of the Service: 43 Florence Avenue is a registered care home for eight adults with learning disabilities. The home is owned and managed by Care Management Group (CMG) and is situated in a quiet residential road in Morden. Public transport, churches, leisure facilities, local shops and the shopping centres of Morden, Sutton and Mitcham are close by. The home is set over two floors with a self-contained flat for one resident within the grounds. The home is staffed twenty-four hours a day. Information about the home is provided to residents and their representatives in a written guide. The current range of fees are £1183.00 to £1509.00 per week. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced inspection. The site visit lasted a total of seven hours. During the site visit the inspectors spoke with the manager and three people who live in the home. Two members of staff were spoken with. Records relating to care planning, staff recruitment and medications were examined. A tour of the premises was undertaken. Information from the home’s Annual Quality Assurance Assessment (AQAA) has also been included in this report. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 6 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who chose to use the service need to be confident that all their needs will be identified. EVIDENCE: People who want to live in the home are assessed prior to admission. They have the opportunity to visit the home and meet other people who live there. There has been one occasion when adequate information had not been obtained prior to admission and there was a personality clash between people who live in the home. This situation has been resolved. The manager reported that she did not expect a situation like this would occur again. The AQAA indicates that there are plans for people to visit the home more prior to moving in and to make sure that current information is available form social services, to inform the home’s assessment. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use the service are supported by staff, but this must be evidenced in the care records, to demonstrate that needs are being met. EVIDENCE: Peoples care plans were examined. These were noted to lead from assessments. Some improvements are needed to make sure that plans are individualised and are person centred. Care plans examined had non-specific goals for people to achieve. The structure of the plans was organised. There were sections for risk assessment, health plans and activities. It was noted that there was some good information on self-care abilities. Care plans did not routinely involve the person in what was being written and did not fully reflect personal choice. For example on person attended a college 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 10 course but did not like it, but there were no alternatives offered to enable that person to develop skills. Pen portraits of people gave valuable information on likes and dislikes and preferred activities. However specific information on goals and timescales is needed to evidence that achievable targets are being set, e.g. meal preparation. People who use the service also have development files, which indicate priority goals i.e. cutting down on the number of carbonated drinks. These files were examined but need to include dates and signatures of staff members completing them. Key worker sessions occur, improvement could be made in the recording of these sessions and the regularity of meeting of the person and their key worker. The AQAA stated that the home is developing person centred plans to make sure staff have a better understanding of individual need and choices. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in the home are able to plan their day and take part in activities, which interest them. Improvement needs to be made to the environment to enable people to develop their skills. EVIDENCE: It was noted on the site visit that people who live in the home are able to choose what they want to do. Some people were supported by staff to go to the local shops. Two people were waiting to attend college in the afternoon. Staff reported that people who live in the home are able to visit friends and relatives. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 12 The communal areas of the home had photographs of holidays and outings people in the home had taken. The manager reported that she had recently returned from taking one person on holiday abroad. People who live in the home are encouraged to prepare their own meals with support. One person made sure the manager had hot drinks throughout the site visit and kindly made the inspectors a drink. Upgrading of the kitchen would make sure that people who live in the home are able to prepare meals in a suitable environment. The current kitchen does not have a large enough oven and is difficult to keep clean due to old flooring and fittings. The AQAA indicated that the home is now fully staffed, which makes sure that all people who live in the home can be supported in their daily activities. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are able to access appropriate health care support. Medications need to be monitored when they are given to make sure that they are handled correctly. EVIDENCE: People who live in the home are able to access appropriate support from health professionals. Records show that a psychiatrist is closely involved with monitoring medications. It was noted that risk assessments on giving sedatives did not contain adequate information. This could lead to people who live in the home being ‘chemically restrained.’ This was discussed with the manager. It is important that when medication is needed for behavioural control there is a clear sequence of events, to make sure this is used as a last resort i.e. a description of behaviour, interventions to be tried before medication is given, when to give ‘as required’ and the result of giving the medication. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 14 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 good This judgement has been made using available evidence including a visit to this service. People who live in the home are able to express concerns they have. Any issues raised are addressed and acted upon. Procedures are in place to protect people form harm. EVIDENCE: People who live in the home are able to make their concerns known. The complaints log evidenced this. People are able to write in this book with any concerns they have. The manager then follows the issue up and details the outcome. Review sessions with people also provide a time for concerns to be addressed. One person had not been happy with the way their concern was handled, but this was being addressed by the home and other agencies. The AQAA show that Safeguarding Adults is a priority. The manager is making sure that all staff receive the necessary training and this has been planned. The AQAA indicated that there have been two Safeguarding Adult investigations, which were both handled in a satisfactory manner. One person who accesses the service said that there should be more recognition of ‘resident upon resident’ incidents. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 15 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 adequate This judgement has been made using available evidence including a visit to this service. People who live in the home are ale to personalise their rooms. Attention is needed in some areas to make sure that the environment is suitable for peoples needs. EVIDENCE: People live in an environment, which would benefit from upgrading to make sure that skills can be develop and people live in a safe home. As previously mentioned work will commence on the ground floor bathroom and the kitchen, to make sure there is suitable equipment and these areas can be kept clean and prevent the spread of infection. A tour of the premises was undertaken. People who live in the home are able to personalise their rooms. The lounge and dining room were clean and tidy and provided sufficient space for people to live in. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 16 Some carpets in bedrooms were stained. The manager reported that a request had been made for replacement flooring. The bathroom on the first floor needed refurbishment, as it was tired looking. The AQAA indicated that when bedrooms are redecorated then the person whose room it is involved in the process and is able to make a choice about colour schemes and furnishings. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who live in the home are supported by a staff team who are aware of their needs. Specific training is needed for staff to make sure that needs are met appropriately. People need to be confident that staff are recruited in a safe manner. EVIDENCE: As reported by the manager the home is now fully staffed. It was noted that one person had one to one care as detailed in their care plan. This makes sure that the person is able to access the community safely. The staffing complement consists of male and female carers of differing nationalities. This makes sure that same gender care can be given when needed. Recruitment procedures need to be improved to make sure that people who live in the home are protected from harm. Staff files were examined. One file did not have two references and employment histories were not fully explored. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 18 Contracts and person specifications were in place. Appropriate checks such as criminal records bureau checks had been carried out. Staff receive training in food hygiene, fire safety and manual handling. However, training is needed in infection control, communication skills, learning disabilities, mental health needs, loss and bereavement and understanding autism, to make sure that staff are suitable skilled to support people. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 and 43 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A manager who has a proactive approach supports people who live in the home. Support is needed from the organisation to make sure changes made improve people’s lives. EVIDENCE: People who live in the home are supported by a manager who is proactive and aware of including people in the running of the home. The manager plans to undertake NVQ Level 4 and the registered manager’s award. Discussion took place regarding the budget for the home. At the time of site visit information was only available regarding the expenditure for the home. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 20 There was no information provided to the manager on fee income. It was noted that on the expenditure adjustments have not been made for inflationary rises in utility bills and local taxes. Therefore a requirement has been made to supply full accounts for the home to CSCI and the manager of the home. This will enable future planning of the service and make sure that there are adequate funds for redecoration and refurbishment. 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 2 32 X 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 3 2 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA2 Regulation 14 Requirement People must be fully assessed prior to moving into the home and all information obtained about them. This will make sure that prospective people are happy with their choice and have an opportunity to meet other people whop live in the home. People’s care plans need to include specific detail, which will make sure that their needs, are met. Reviews of the care plans and needs of people who live in the home must involved the person or their representative. This will make sure that people who live in the home have their views heard. Changes in medications must be recorded and documented accurately to protect people who use the home from harm. A full budget for the home must be submitted to CSCI and the home’s manager to make sure that sufficient funds are available for the running of the home. Staff need to receive training in specialist areas to make sure DS0000027216.V349116.R01.S.doc Timescale for action 30/03/08 2 YA6 15 30/03/08 3 YA6 15 (1) 30/03/08 4 YA20 13 (2) 30/03/08 5 YA43 25 (2) (c) 30/03/08 6 YA32 18 (1) (a) 30/03/08 43, Florence Avenue Version 5.2 Page 23 7 YA34 19 8. YA24 23 (2) (b) 9 YA24 23 (2) (b) they have the necessary skills with which to support people who live in the home. Suitable recruitment processes need to be in place to make sure that people who live in the home are protected from harm. All necessary checks must be made prior to an individual commencing employment. The ground floor bathroom must be fully renovated to make sure that people who use the home are able to access suitable facilities, which can be kept clean. There must be suitable kitchen facilities to enable people who use the home to prepare meals and make sure there is sufficient space for staff to work in. 30/03/08 30/03/08 30/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 43, Florence Avenue DS0000027216.V349116.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!