CARE HOME ADULTS 18-65
46A EASTERN AVENUE 46a Eastern Avenue Reading Berks RG1 5RY Lead Inspector
Debbie Willcox Unannounced 23 August 2005 10.00 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. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 46A Eastern Avenue Address 46A Eastern Avenue Reading Berks RG1 5RY 0118 9263510 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) Milbury Care Services Ms Katharine Doyle Care Home 6 Category(ies) of Learning disability (LD) registration, with number of places 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 17 January 2005 Brief Description of the Service: 46a Eastern Avenue provides care and accomodation for 6 adults between the ages of 18 and 65 who have learning disabilities. The house is owned and the service provided by Milbury. The home has a lounge/dining area and separate kitchen. There is a laundry area located in a small cupboard on the landing. There is a private enclosed garden and patio to the rear of the property and parking for several cars to the front of the property. All service users have their own single bedroom, which is decorated to their personal choice. Two bedrooms are located on the ground floor. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on a weekday over a 3-hour period of time. Time was spent talking with 3 of the 5 people resident within the home and three staff members. The manager of the home has recently been registered with the CSCI and is currently on maternity leave. What the service does well: What has improved since the last inspection?
The home has a much more organised and structured feel with management systems put in place to improve record keeping and general administration. Staff issues are now being addressed and the best interests of those living within this home are being seen as the priority in how the running of the home is organised and managed. Social, community activities and work opportunities for residents have increased. Each resident has an activity planner and organiser. People living within the home say that they have more opportunities to go out and are much more involved in shopping and cooking and household chores, which they enjoy and are gaining skills and independence. There has been decoration to bedrooms and bathrooms and the home was found to be cleaner and clutter now removed.
46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 6 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. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 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 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 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) 1,4,5 Information is provided for prospective service users and opportunities provided to visit the home prior to admission. EVIDENCE: There have been no new service users to this home since the last inspection. The home has one vacancy and prospective residents are being assessed and relatives have been visiting the home. The home provides a statement of purpose and service users guide to all prospective residents. Each service user has a service agreement. This is printed in a format that is appropriate for this service user group. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 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) 6,7,8,9, Care planning has improved and staff given written guidance in how best to meet the needs of those living within this home. Service users know that staff will treat them with respect and promote their independence. EVIDENCE: Each service user has a plan of care, which has been updated since the last inspection. Service users files are more organised and accessible. Two service user files were viewed. There was no evidence of a regular review of care plans. Care plans have not been dated when they were compiled. Care plans are written as though written by the service user clearly outlining choice and likes and dislikes. Risk assessments have been updated but do not have dates set for review or guidance as to how often they should be reviewed. The provision of annual reviews has improved with almost all service users now having been conducted and others planned for. People living in the home told the inspector that staff treat them with respect and ask their opinions and offer choice as to how they live their daily lives.
46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 10 This was further evidenced from observation and from the viewing of daily communication books and diaries. Service users said that since the new manager has come to the home they are involved much more in the way the home is run and their opinions sought. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 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) 11,12,13,14,16, Staff support services users in this home to enjoy opportunities for personal development and social and community involvement. Service users rights are respected and their independence promoted. EVIDENCE: Since the last inspection opportunities for service users to participate in community life has improved. Each service user has an activity planner which details planned daily activities and outings. This has been put together in a format, which is service user friendly. One service user has access to paid work and staff are working with another service user to access gardening work. Service users attend a resource centre and stepping stones where 1-1 support is provided for service users to gain skills in cooking, needlework, reading and writing. One service user has recently gained a certificate in food hygiene. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 12 Service users have access to community activities including shopping, visits to church, a local pub and meals out. All service users spoken with said how much they appreciate going out on a regular basis. Independence is promoted; residents are actively involved in household chores. Holidays have been organised and service users said how much they have enjoyed them and those about to go on holiday spoke of their involvement in choosing where to go. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 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) 18,19,20,21 Service users can be assured that they will receive personal support in the way they prefer and require and staff will support them to access health care support. The home must ensure that care plans and risk assessments are reviewed regularly. EVIDENCE: The homes system for storing, recording and administration of medication was inspected and found to be in good order. Staff are competency assessed for handling medication but no external training is provided. Two service users files were viewed at this inspection. One of the two files viewed contained information guiding staff as to a service users wishes in event of death or terminal illness. The majority of service users require minimal assistance with personal care. Care plans detail how service users want to be addressed and assisted with personal care. It was evident from written information that service users have access to health services. Both files viewed contained a medical health profile including a profile of medication prescribed. Service users have access to an annual health check.
46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 14 Weights are regularly monitored. There was evidence of psychologist assessments being provided and reviews undertaken. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 15 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) EVIDENCE: Not assessed at this inspection. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 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) 24,25,26,27,28,30, Improvements to the kitchen and gardens are needed to improve the environment for those living within this home. Service users have rooms that reflect their personality, needs and lifestyles. EVIDENCE: A tour of the home was undertaken. There has been improvement with some rooms including bathrooms having been decorated since the last inspection. All service users rooms suit the needs of those resident and reflected individuals personalities. A previous requirement for the front garden wall to be repaired has not been responded to. Staff have attempted to improve the gardens and have involved service users in this project. However the back garden does have rubbish piled up at the back of the garden and areas full of weeds. An immediate requirement was issued at this inspection with a 1-month timescale for rubbish and weeds to be cleared and the front garden wall repaired.
46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 17 The kitchen is in need of refurbishment and decoration. Staff informed the inspector that this work is due to be carried out within 6 weeks. The home was found to be clean throughout. The laundry areas are located in a small cupboard that is not ideal, as this room does not contain sluicing or hand washing facilities. Following a requirement made at the last inspection a risk assessment has been undertaken and guidance issued to staff in accessing the nearest hand washing facilities. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 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) 31,33, Rotas do include the full names of staff and their designation. Rotas indicate ratios of staff that meet the current needs of those living within the home. EVIDENCE: Staff rotas do not detail the full names of staff and designated roles and this must be addressed. It was not possible to inspect staff files at this inspection. Staff meetings are conducted on a regular basis and meeting minutes evidenced a home run for the benefit of service users. The home has several vacancies with recruitment in process. The home has managed to avoid the use of agency staff and maintain cover through the use of bank/relief staff. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 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 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) 37,38,39,42 There is clear leadership and this home is managed for the benefit of service users. EVIDENCE: There has been a general improvement in the running and organising of this home since the last inspection. Management systems are in place to ensure improved record keeping. Service users spoken with all said that they like the new manager and think that things have improved with more opportunities for social and community activities being provided. Staffing issues relating to rota and lateness are being addressed. Communication books and discussions with staff evidenced improved team working. It is apparent that the rights and needs of service users are being promoted and safeguarded. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 20 There was evidence of only one residents meeting having been conducted since the last inspection. However the home does conducted monthly 1-1 meetings between the service user and keyworker and these are recorded. The manager of this home has recently been registered with the CSCI and is now on maternity leave. Alternative management arrangements are now in place with the deputy manager acting up into the managers post. Risk assessments have been updated but do not always have a date for review or indicate what regularity they should be reviewed. Fridge and freezer temperatures are recorded daily. Food was found to be stored safely. 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 x 3 Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 2 3 2 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 2 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 x 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
46A EASTERN AVENUE Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 22 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 24 Regulation 15(1)(2) Requirement Service users care plans and risk assessments to be reviewed at least six monthly and updated to reflect changing needs. Bathroom sealant to be replaced and tongue and groove panelling repaired. The side wall to the front of the building to be repaired. ORIGINAL TIMESCALE FOR COMPLIANCE WAS 01.04.04 Staff rotas to detail full names of staff with job role designated. Rubbish and weeds to be cleared from the back garden. Timescale for action 01/11/05 2. 3. 24 24 23 23(b) 01/10/05 23/09/05 4. 5. 6. 33 24 Schedule 4 (7) 23(2)(o) 01/10/05 23/09/05 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 Good Practice Recommendations 46A EASTERN AVENUE H51 H01 11050 46A Eastern Avenue V230739 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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