Inspection on 26/05/06 for 46 Severn Avenue

This inspection was carried out on 26th May 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

46 Severn Avenue 03/11/08

46 Severn Avenue 20/11/07

46 Severn Avenue 29/05/07

46 Severn Avenue 08/02/06

46 Severn Avenue 20/12/05

46 Severn Avenue 05/10/04

46 Severn Avenue 25/05/04

46 Severn Avenue 13/01/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 46 Severn Avenue Weston Super Mare North Somerset BS23 4DQ Lead Inspector Paul Grey Unannounced Inspection 26th May 2006 09:30 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 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 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 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. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 46 Severn Avenue Address Weston Super Mare North Somerset BS23 4DQ 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) 01934 626731 0117 9699000 The Brandon Trust Mrs Beverley Cole Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 6 persons aged 30 years and over Date of last inspection 8th February 2006 Brief Description of the Service: Severn Avenue is a small home situated in a pleasant suburban area of Weston-super-Mare. The home provides support for up to 6 service users with varying degrees of learning disability. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted in the absence of the manager over a 5 hour period. The Inspector found a pleasant, well-run home with a relaxed service user group and positive staff team. During the inspection the Inspector spoke with 3 service users, 2 staff members, 1 visitor and conducted a tour of the premises. The Inspector completed an audit of the homes care files and general documentation. In the managers absence the Inspector was unable to access confidential staff files. As a consequence the Inspector was unable to assess a number of documents normally covered during a key inspection. The Inspector commends the manager and staff team on their efforts and overall presentation of the service. 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 contacting your local CSCI office. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 6 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 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 7 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 the following standard(s): 2 The outcome the service users was good. Service users needs and aspirations are assessed. EVIDENCE: There have been no recent admissions to the service. The Inspector audited service user assessed documentation. There have been no recent admissions to the service so the service user assessments were all. The Inspector found evidence that service users were assessed prior to and during their stay at the home. The Inspector and observed and service users had the required copy of the summary of care management from the care manager contained within service users folders. The Inspector noted evidence in 3 care plans audited that the service user assessment was used to generate service user care planning. There was some confusion and repetition regarding service user assessment, and the implementation of the Brandon trust person centered planning document. The home appears and clear as to which document they should be using. The Inspector noted no unreasonable restrictions on service user freedom. Any restrictions that the Inspector noted were on the grounds of health and safety and in the best interests of the service user. These restrictions typically involved service users being accompanied to go to town etc rather than being able to go on their own. Staff spoken with inform the Inspector that the family 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 8 members interests and needs would be taken into account if they were relevant to the service users care. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 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 the following standard(s): 6, 7, 9 The outcome of the service users was good. Service users assessed needs a reflected in the service users plan of care. Service users make decisions about their lives with assistance as needed. Service users are supported to take risks as part of an independent lifestyle. EVIDENCE: The Inspector audited 3 plans of care. The Inspector was able to track service user assessment through to service user care planning. The home appears to have 2 separate processes for assessing and implementing care. The home uses the older existing Brandon paperwork in conjunction with the newer Brandon person centered planning. There was a degree of overlap between these 2 systems which appear to be integrated as one. The Inspector also noted a degree of repetition between these 2 documentation systems. The Inspector was able to track how to need was assessed, care planned and reviewed. Plans of care described any restrictions on choice or freedom for the service user. As previously mentioned , this would typically involve health and safety issues as service users were 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 10 unsafe to leave the premises for example. The Inspector noted that there were clear outlines for service users who potentially could be aggressive or inappropriate in the community. This was appropriately risk assessed. The Inspector noted evidence of service user involvement in drawing up of care plans. All service users had a designated key worker with the support worker. The Inspector was able to find evidence that the staff team support service users to make decisions in their own right. This evidence was particularly clear in the Brandon person centered planning documentation. It was somewhat less clear from the older notes. The Inspector was able to track how service users choices were made and how they were supported by staff at the home. This was good. The Inspector noted that any limitations on service users choice was done in the service users best interests and consistent with health and safety and the purposes of the home. The Inspector audited service user risk assessments. These were thorough, and maintained up to date. The Inspector was able to track identified risks and activities or interventions by staff to minimise identified risk. The Inspector noted the home had a policy and procedure for action in the event of an unexplained absence by service user. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 15, 16, 17 The outcome the service users were good. Service users are able to take part in appropriate activities. Service users are part of the local community. Service users have appropriate personal relationships. Service users rights are respected in their daily lives. Service users are offered a healthy diet to enjoy their meals and mealtimes. EVIDENCE: Service users at the home do not participate in paid employment. Service users are supported by the staff and day care workers to participate in a range of activities designed to be stimulating, educational and develop life skills. This process encourages service users to be involved in communities outside of the home and in the community as a whole. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 12 Service users are supported to participate in the local community via day care and staff support. Service users may be supported to attend local shops, the cinema, go out to local cafes and generally enjoy facilities in the Westonsuper-Mare area. The Inspector found documentation of a range of day care activities and day care support to substantiate this. At the time of inspection for service users were in gauged in day care activity. Staff at the home would support service users from different racial or cultural background is inappropriate. The home reflects the North Somerset demographics with regards to the racial and cultural mix. The Inspector noted evidence in the person centered planning documentation that the staff team will support service users to maintain relationships outside of the service. The staff member spoken with informed the Inspector that staff will help with phone calls, letters, and prompts for birthday cards to relatives etc. Service users are supported to develop and maintain relationships by the staff team outside of the service. The Inspector noted the home has in place policies and procedures should service users wish to develop more personal relationships with people of their choice. This is not an issue at present. Service users are supported by a flexible routine in the house. The Inspector noted from documentation and from speaking with staff that service users may be prompted to attend their day care activities. Otherwise, service users may get up as they wish, and eat as they wish within some reasonable constraints. During inspection the Inspector observed the staff team interact well with the service users and the service users were involved in conversations between the Inspector, staff and service users. Service users at the home had around pleasant rooms, they may withdraw to these if they do not wish to be in the communal areas. Service users have unrestricted access to the home and the grounds; the front door is often left open to enable service users to come in or out as they please. The Inspector spoke with the staff regarding safety issues and the opening of the front door. The front door is left open to enable service users to wander freely in and out of the home around the garden. Because of service users risk assessment service users are unable to leave the garden without the gate being activated from inside the home. Given the risk assessments, this is good practice. However anybody can enter the garden and possibly the home with the front door open. As a consequence the Inspector recommended that a door chime is fitted or some form of infrared chiming alarm so service staff are aware of service users passing in and out of the door. The Inspector recognises this may be activated frequently but is aware of no better alternative. The Inspector noted service users are encouraged to participate in daily chores such as cleaning of rooms and hoovering. These were not unduly onerous and 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 13 could be changed if service users wished. The Inspector noted a pleasant fourweek rotating menu was available for service users. The Inspector did not look into this in any detail but previously the home has met national minimum standards. Service users informed the Inspector that the food at the home was nice. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 18, 19, 20 The outcome of the service users was good. Service users receive personal support in the way they prefer. Service users physical and emotional needs are met. Service users are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Service users are provided with sensitive and flexible support from the staff team. The Inspector found evidence in the person centered planning document as to how staff were to approach issues such as the service users presentation, aspects of their behaviour all personal hygiene. It is clearly outlined in the documentation, and there is evidence of appropriate training to support staff to be flexible, and discreet about prompting service users of issues like personal hygiene. The staff on duty inform the Inspector that service users are supported to choose their Rome clothing and decide their own hairstyle etc. No service users require technical aids for independence. The Inspector noted evidence of an ongoing process of assessment of service users general health care. The Inspector noted documentary and statement 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 15 evidence from staff as to the support given to service users with medical issues if and when they crop up. This was corroborated by both GP appointments and care planning. Service users at the home have been risk assessed and are unable to dispense their own medication. The Inspector checked the records of medication administered and received at the home. The Inspector noted there were no omissions or crossings out and medication had been administered appropriately. Medication was stored in accordance with a Royal pharmaceutical Society guidance and appropriate stock checks were in place. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 22, 23 The outcome for service users was good. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self harm. EVIDENCE: The Inspector noted that the home has a clear complaint procedure. This is a standard Brandon trust document. One service users spoken with informed the Inspector that they knew who to talk to if they were unhappy. Staff spoken with inform the Inspector that the homes complaint procedure had been given to or explained to the service users. Given the small size of the home and the close nature of the staff/service user relationships, service users would generally complain informally to a staff member if they were unhappy about something. The Inspector noted evidence of one complaint previously that had been dealt with satisfactorily. Records are kept of all complaints made. Service users at the home are protected from abuse via staff training, the homes policies and procedures and training provided by the Brandon trust. The Brandon trust provide training for staff to understand the nature of abuse, how it may be perpetrated, how to detect it, and how to report or deal with it should a staff member suspect its occurrence. Training is provided to staff to understand the causes of verbal and physical aggression and how to manage the situation should it arrive. Staff who may be unsuitable to work with 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 17 vulnerable adults are screened from working with the vulnerable adults at the home. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 18 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 the following standard(s): 24, 30 The outcome of the service users was good. Service users live in homely and pleasant environment. The home is clean and hygienic. EVIDENCE: The home is domestic in scale and generally presents a homely environment. There are a number of outstanding requirements on the environment of the home that these are mostly related to maintenance. The Inspector noted that the fire door on one of the service users bedrooms (D.W) and (G.M) do not close properly. The Inspector requires these doors be adjusted, as they are fire doors. The Inspector notes that this requirement was made previously and does not appear to have been addressed. Should the fire door not be addressed by a subsequent follow-up inspection the Inspector will recommend enforcement action. The premises were generally clean, bright and cheerful. The home was clean and hygienic throughout; the Inspector noted no offensive odours. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 The outcome for service users was adequate. Service users are supported by a competent and qualified staff. The Inspector can find insufficient evidence to conclude that the home protects service users by implementing appropriate recruitment procedures to screen inappropriate applicants. Service users individual and joined needs are met by appropriately trained staff. EVIDENCE: On observation of staff during inspection, the Inspector noted staff were friendly and approachable to service users. The staff team appeared to interact well with the service users on the premises. The Brandon Trust supports staff to acquire and maintain the skills necessary to communicate with and understand service users needs. Recruitment is dealt with centrally by the Brandon trust. On perusing staff records the Inspector found for records with insufficient evidence to indicate that appropriate references, forms of ID, POVA and CRB checks have been obtained. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 20 As a consequence the Inspector is unable to find enough evidence to conclude that the home meets national minimum standards regarding this issue. In the managers absence the Inspector was unable to access staff supervision. From staff feedback, and notes made elsewhere the Inspector found evidence to indicate that appropriate supervision does occur with reasonable frequency. The Inspector will review this standard on the next inspection. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The outcome the service users were good. Service users benefit from a well-run home. Service users are confident their views effect the way the home is run. To health, safety and welfare of service users is protected. EVIDENCE: The home had previously undergone a period of change with its manager. The home has a new acting manager, David Rogers, who is in the process of applying to the commission to become the registered manager. The home has policies and procedures relating to its quality assurance and quality monitoring mechanisms. The Inspector audited the files he was able to find, the Inspector noted there was an annual development plan but was unable to find documentation of its recent implementation. The Inspector will follow this up on a subsequent inspection. The Inspector noted that the 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 22 feedback is actively sought from service users, either one-to-one from the key worker or during service user meetings. The Inspector gathered staff statement evidence which indicates that the views of families, advocates all stakeholders are taken into account. Service users are informed about unannounced inspections and are happy to speak with the Inspector about the service. Policies, and procedures or reviewed in the light of changing procedures and clinical guidance. This is done centrally by the Brandon trust. The Inspector noted evidence of appropriate lifting and handling training. The Inspector noted that the staff team were out of date with regards to fire training. This was subject to requirement. The Inspector noted that fire training had been scheduled prior to the inspection and that it was only a few months out of date. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 2 b Requirement The Inspector noted the fire door into one service users bedroom does not close properly. The fire door is located at the top of the stairs, as you enter the first bedroom on the l2 This must be remedied. The fire door must be able to close correctly. This was a requirement outstanding from the previous report. The downstairs all carpets proceeding along into the corridor must be replaced. At the time of inspection, the manager was unable to find the statement of purpose for the home. The Inspector requires that a statement of purpose be found or written within the period defined. The Inspector was unable to find a statement of purpose on the premises. Staff present were also unable to find one. The Inspector requires that an up-to-date statement of purpose 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 25 Timescale for action 08/06/06 2. YA24 23 2 b 08/08/06 3. YA1 41a 01/06/06 4. YA1 41a 30/06/06 5. YA42 13 1 6 must be maintained on the premises at all times. The Inspector requires the home to maintain a staff fire safety training in accordance with the Brandon Trust policies and procedures. 30/06/06 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 YA16 Good Practice Recommendations The Inspector recommends the home consider the use of some form of movement activated chiming alarm so that staff are aware of people passing in and out of the front door. 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 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 46 Severn Avenue DS0000008130.V293371.R01.S.doc Version 5.1 Page 27 - 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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