Inspection on 24/05/05 for 43, Florence Avenue

This inspection was carried out on 24th May 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

43, Florence Avenue 15/05/08

43, Florence Avenue 11/09/07

43, Florence Avenue 26/06/06

43, Florence Avenue 28/11/05

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

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

CARE HOME ADULTS 18-65 Florence Avenue, 43 43 Florence Avenue Morden Surrey SM4 6EX Lead Inspector Liz OReilly Unannounced 24 May 2005 10:00 am th 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 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 Stationary 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. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Florence Avenue, 43 Address 43 Florence Avenue Morden Surrey SM4 6EX 0208 646 5921 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Management Group Ltd Dawn Anne Louise Raw CRH Care Home 8 Category(ies) of LD Learning Disability (8) registration, with number of places Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Eight Adults (M/F) with Learning Disabilities Date of last inspection 20th December 2004 Brief Description of the Service: 43 Florence Avenue is a registered care home for up to eight adults with learning disabilities. The home is owned and managed by Care Management Group, a privately run company that owns a number of other establishments. The home is in keeping with neighburing houses and is not identifiable as a care home. 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. All residents have their own bedroom and two residents within the main buliding have their own en suite bathrooms. The home is staffed twenty four hours a day. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one regulation inspector on 24th May 2005 over six hours. During this visit the inspector met six of the eight residents, the deputy manager and four staff. What the service does well: What has improved since the last inspection? What they could do better: In order to fully meet the needs and expectations of residents the care planning system should be improved. Further work should focus on providing residents with greater opportunities to take part in activities outside the home. In order to ensure the health, safety and welfare of residents the recruitment procedure, the training on protecting residents and training on dealing with complaints should be reviewed. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 4 The admission procedure is followed to ensure that the needs and aspirations of prospective residents are assessed prior to admission. As part of the process of ensuring residents have as clear an understanding of the service residents are invited to spend time in the home prior to making any decision about moving in. EVIDENCE: Pre admission assessments are carried out for each prospective resident to ensure that the home has information on, and can meet the needs and aspirations of each residents. One area of the pre admission process which requires further development concerns restrictions on choice and freedom. To ensure the rights of residents any restrictions on choices or freedom of movement must be discussed and agreed with the resident and their representatives during the assessment. Residents are invited to “test drive” the service by spending varying lengths of time in the home, including over night stays prior to moving in. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Individual action plans are not used as a working document nor are they reviewed at sufficient intervals to ensure that the changing needs and personal goals of residents are reflected in the plan. Staff respect residents rights to make decisions about their day to day activities. However to ensure that all staff are aware of individual choices the individual action plans must be up to date and reviewed on a regular basis. In supporting residents to maintain or develop independence staff take note of and assess possible risks to individuals. EVIDENCE: An individual action plan is produced for each resident. This sets out needs and wishes of residents along with the action to be taken and the coordinator responsible. One action plan seen was dated April 2003 with the last review being dated March 2004. The reviews seen contained detailed information but in order to ensure that the needs and wishes of residents are met reviews must be carried out at least six monthly or more frequently should there be any changes. The reviews seen Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 10 did not include any outcomes. Discussions with staff at this visit indicated that the actions plans in place were not referred to on a regular basis. The requirement made at the time of the last inspection of this home relating to care planning is carried forward. Residents were seen to be encouraged and supported by staff to make their own decisions on day to day activities. In order to protect the right of residents to make decisions regarding their own lives staff must ensure that in instances where decisions are made by others on behalf of a resident a record of those involved in any decision and why must be in place. To ensure that residents are supported appropriately to maintain and develop independence individual risk assessments are carried out and reviewed. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14, 16 & 17. Staff support three residents to participate in attending local colleges. This provides these residents with educational and social activities outside the home. Further work needs to focus on supporting those residents who have more difficulties in participating in appropriate external activities. Staff make clear efforts to provide individualised leisure activities for residents taking into account individual interests and preferences. Residents are supported by staff to maintain and develop independent living skills according to individual needs and strengths. Residents stated they enjoyed the food provided. EVIDENCE: Three of the eight residents in the home attend regular courses at local colleges. Staff were seen to provide support and information to these residents to continue with these activities. Staff stated that one resident had tried a college course but had refused to continue. In order to expand the educational and social activities available further work needs to focus on Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 12 seeking out and offering alternative, external structured activities for those residents not attending regular activities. Staff were found to be well informed of the individual interests of residents and made clear efforts to meet day to day requests for activities. To ensure their safety, one resident is provided with a two to one staffing ratio when engaging in activities outside the home. One resident stated they enjoyed outings to the coast and to local pubs. Outings to Epsom Downs, local garden centres, shopping centres and Boxhill have also been provided. Two residents stated they enjoyed a Monday Club disco. Residents have access to the home’s own transport with three residents able to use public transport. Residents are provided with opportunities to take an annual holiday away from the home. Two residents have been on holiday this year. One resident was planning a trip to France and two residents a trip to Butlins. Staff were seen to respect the privacy of residents in their day to day lives. Residents were seen to make their own choices about when they wished to be alone or with others. As noted at the last inspection in order to ensure the rights of residents in relation to freedom of movement all residents must be provided with the means of accessing and exiting the building. Should individual risk assessments indicate a resident should not be supplied with the means for exiting the building this must be documented along with the names of all those involved in this decision. All residents should be offered a key to their bedroom. Residents have access to the kitchen in the home at all times. Comments from residents and observations made at the time of this visit indicated that residents enjoyed the meals and were offered clear choices with opportunities to assist in the preparation of food. To ensure that all residents are provided with a varied diet a record of food is retained in the home. Staff were observed offering advice to residents on healthy eating. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 20 Systems are in place to ensure the health care needs of residents are met. The health and welfare of residents is protected by well managed medication procedures. EVIDENCE: Residents are registered with local GP practices. Dental and optical checks are arranged on a regular basis with appropriate services to meet the needs of individual residents. Community nursing services are arranged if required. The consultant psychiatrist visits the home on a regular basis. Medication records are well maintained. At the time of this visit to the home medication records were up to date. Medication was stored, administered and managed in a manner which protects the health, safety and welfare of residents. Staff who administer medication have been provided with training. The registered persons should confirm to the Commission that the training provided had been accredited. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 A complaints system is in place to ensure the views and concerns of residents are listened to and acted upon. All staff need to be provided with training on dealing with complaints. In order to safeguard residents policies and procedures in relation to protection from abuse are in place. Further work needs to be carried out to ensure that all staff have been provided with training on the protection of vulnerable adults. EVIDENCE: In order to increase access for residents the complaints procedure is produced in written and pictorial form. One resident informed the inspector that should they have any complaints they would go to the manager who they felt would “sort things out” for them. This resident was confident that staff would listen to any concerns. In order to ensure that residents or other complainants are satisfied with the results of any investigation and actions taken a record of outcomes must be kept in the home. To ensure that all complaints are handled appropriately all staff must be provided with training on dealing with complaints. Procedures are in place for the protection of residents from abuse. The policies and procedures were seen to be available to staff in the home. Discussions at the time of this visit indicated that the majority of staff had received training on the protection of vulnerable adults but newer staff to the home had not been provided with this training. In order to ensure that all staff are aware of their responsibilities in recognising and reporting any suspected abuse all staff must be provided with training on this issue. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 15 Facilities are available in the home for residents to deposit money in the home for safekeeping. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Residents are provided with a comfortable homely environment which is well maintained and clean. The laundry area of the home is not sufficient to fully meet the needs of the residents in the home. EVIDENCE: The premises are well maintained and residents are provided with comfortable, good quality furnishings in communal areas. Residents have access to a small dining room, a lounge and a quite/activities area. This allows residents a choice of areas to relax or take part in group activities. Residents were seen to have access to all areas of the home including a well maintained garden equipped with seating. The home is bright, airy and well ventilated. The location of the home allows residents to have easy access to local shops, public transport and community leisure facilities. The laundry area of the home is small and does not allow sufficient space or facilities for residents to be supported by staff to maintain or develop their Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 17 independence in this area of daily living. Staff informed the inspector that the organisation were looking into ways in which the home could be extended to provide better laundry facilities. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34 and 35 Sufficient staff were seen to be on duty on each shift to meet the needs of the present resident group. Further work needs to be carried out to ensure that residents are protected by the recruitment procedures in the home. Staff are provided with good opportunities for training to ensure residents are cared for by staff with appropriate training. EVIDENCE: Residents gave positive comments on the staff in the home. One resident stated that they “really liked” certain members of staff. Staff were seen to interact with residents in an appropriate and positive manner. Residents who were unable to give verbal comments on the staff group were observed to be relaxed and to take the initiative in their interactions with individual staff members. Between three and five members of staff are available on duty in the home during the day depending on the number of residents in the home and the activities on any one day. The staffing levels are kept under review to ensure they continue to meet the needs of the residents in the home. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 19 In order to protect the privacy and dignity of residents female staff are always available to provide personal care for female residents. The organisation seeks to ensure that residents benefit from a knowledgeable workforce by providing on going training. Discussions with staff and examination of records indicated that the opportunities for staff training had significantly improved since the last inspection of the home. One member of staff is in the process of completing NVQ level three training. All bar three staff are in the process of completing NVQ level two training. The registered manager and the deputy manager are in the process of completing the Registered Managers Award. Further work needs to be carried out to ensure that residents are protected by appropriate checks being completed before new staff are employed within the home. The references available for one members of staff were addressed “to whom it may concern”. The registered persons must ensure that the organisation contacts any referees directly to request a reference which relates to their employment in this home. The registered persons must ensure that Criminal Records Bureau checks are carried out prior to any person commencing work within the home. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 Residents are not provided with an opportunity to be involved in a review of the care provided in the home. Checks are carried out on the building and equipment to ensure the health and safety of residents, staff and visitors to the home. EVIDENCE: The organisation has not carried out a review of the quality of care provided in the home on an annual basis. Quality assurance and monitoring systems based on seeking the views of residents need to be implemented to enable staff to measure success in achieving the aims, objectives and statement of purpose of the home. The views of service users on the home must be sought, published and made available to other service users. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 21 In order to safeguard the health and safety of residents, visitors and staff regular checks are carried out on the fire alarm system, hot water temperatures, fridge and freezer temperatures. A record of all accidents and incidents is maintained. Regular fire drills are carried out. Discussions with staff indicated that a qualified first aider was available on each shift. The registered persons must confirm in writing that these staff have been provided with the appropriate four day first aider course. To ensure the health and safety of residents all other staff must be provided with the emergency first aid training. Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 2 3 x x 2 3 Standard No 31 32 33 34 35 36 Score x 3 x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Florence Avenue, 43 Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score x x 1 x x 3 x G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 23 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 6 Regulation 15(1)(2) Requirement The Registered Persons must ensure that evidence is available to show that outcomes are recorded in relation to care planning, that the care provided is in line with the plan and that service user plans are reviewed on a six monthly basis or more frequently should there be any changes in individual needs. The Registered Persons must ensure that all service users are supplied with a means of accessing and exiting the building independently. Where risk assessments have indicated that to do so would jeopardise the health and safety of an individual a clear record of the reasons for restricting freedom of movement must be in place along with the names of those involved in reaching this decision. The Registered Persons must ensure that a record of the investigation process and outcomes is available in the home in relation to any complaints received.The Registered Persons must ensure Timescale for action 1st September 2005 2. 16 17(1)(a) Schedule 3(q) 1st September 2005 3. 22 22(3) 18(1)(c) 1st September 2005 Florence Avenue, 43 G54-G04 S27216 Florence Avenue V228058 Stage 4.doc Version 1.30 Page 24 4. 23 18(1)(c) 13(6) 5. 34 19(1) Schedule 2 17(2) Schedule 4 (6) 24(1)(2) 6. 39 that all staff working in the home are provided with training on dealing with complaints. The Registered Persons must ensure that all staff working in the home are provided with training on the protection of vulnerable adults. The Registered Persons must ensure that a review of the information held on staff files is carried out to ensure that all documentation required by the regulations are in place. The Registered Persons must ensure that a review of the quality of care provided in the home is carried out. A copy of the report produced following any such review must be provided to the Commission. 1st September 2005 1st September 2005 1st September 2005 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. 2. Refer to Standard 6 20 Good Practice Recommendations The Registered Persons should ensure that service user plans are provided in an appropriate format for individual service users. The Registered Persons should ensure that all staff who administer medication are provided with accredited training on the management of medication. 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