Inspection on 15/02/06 for 5 Courtenay Avenue

This inspection was carried out on 15th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

5 Courtenay Avenue 30/05/07

5 Courtenay Avenue 29/09/05

5 Courtenay Avenue 10/02/05

5 Courtenay Avenue 09/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

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 5 Courtenay Avenue 5 Courtenay Avenue Harrow Middlesex HA3 5JH Lead Inspector Clive Heidrich Unannounced Inspection 15th February 2006 3:00 5 Courtenay Avenue DS0000017570.V283864.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 5 Courtenay Avenue DS0000017570.V283864.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. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 5 Courtenay Avenue Address 5 Courtenay Avenue Harrow Middlesex HA3 5JH 020 8421 0466 020 8621 7244 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) T/A Idelo Limited Ms Diane Morleen Elizabeth Eastman Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 Brief Description of the Service: 5 Courtenay Avenue is registered to provide accommodation to 3 adults who have learning disabilities. It has been registered since 17/11/99. There was one service user vacancy at the time of the inspection. The house is a semi-detached dwelling in an ordinary suburban street within Harrow. It is close by to the organisations other care home. The home is on a bus route that allows access to the community facilities within central Harrow. There are also small local shops that service users can access. There is a house car that offers service users a transport facility. The home does not have its own parking facilities apart from adjacent street parking. The home has one bedroom for service users downstairs, and two upstairs. There is a bathroom upstairs and a shower room with toilet downstairs. Access to the first floor is by stairs only. The home has a good amount of communal space through the provision of a lounge, a dining area, and a cabin for smoking within a good-sized garden. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across a cool February afternoon. It finished at 6:20p.m. Its focus was on compliance with previous inspection requirements and with assessing core inspection standards that were not considered at he previous inspection visit. Both service users were present at the start of the inspection. The inspector met with them individually to discuss the services provided in the home. The inspector also discussed aspects of the service with staff working during of the visit, and with management. Additionally, care practices were observed, much of the environment was checked on, and a number of records were sampled. Concurrent to the inspection, the manager was requested to send out comment cards to involved people, and to complete an inspection questionnaire. Consequently the CSCI have received comment cards from four health and social care professionals. Comments have been entirely positive, and some details of these can be found in this report. The inspector thanks all involved in the home for the patience and helpfulness during and after the inspection. What the service does well: What has improved since the last inspection? All requirements from the previous inspection have been addressed. This includes in particular, requirements about medication management, updating service users’ individual risk assessments, and making suitable records of managing service users’ money. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 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. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 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 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 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 the following standard(s): 2 Prospective service users’ needs and suitability to the service offered by the home are suitably assessed by management prior to the offering of a trial placement in the home. EVIDENCE: The managing director discussed with the inspector about the long-standing vacancy in the home. He spoke in terms of aiming to find someone who fits in with the service on offer and who would get along with the two service users who live in the home. These aims have so far not been matched by the few prospective service users who have visited the home. The resident service users confirmed that prospective service users have come to look at the home, with a view to moving in, since the last inspection. The home’s admissions policy was seen at previous inspections to be suitable. 5 Courtenay Avenue DS0000017570.V283864.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 and 9. The service provides service users with good standards of care planning and risk management. Service users are also provided with good standards of individualised supported to look after their money. EVIDENCE: There are straightforward care plans in place for each service user. The plans have been updated in line with the outcomes of each service user’s last CPA meeting, as is appropriate. Risk assessments have also been updated in this respect. Plans additionally have goals in place for each service user, which have been signed by the service user. These goals relate to trying to achieve such things as health improvements, better personal care, and budgeting. Both service users stated that their money is looked after by the service at a level that suits them. The support required is documented within their individual plans. Discussions with service users, staff, and management found that these plans are reasonable and are regularly reviewed. Records of the ongoing spending of the money are in place and transparent. The service user signs for receiving the money, and receipts are in place for major and unusual purchases. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 10 It is recommended, for further security and transparency of the transactions, that the staff member involved in passing money onto the service user also signs the money records. Both service users spoke about how staff support them with managing risks that are relevant to them. For instance, one service user’s room has been rearranged, with their consent, with the aim of preventing accidents. One service user was pleased with how staff are supporting them to maintain their health. Staff also showed awareness, in discussions, about key risks to service users and how they provide support to minimise the risks. Written risk assessments, that are up-to-date and suitable, are in place on service users’ files. 5 Courtenay Avenue DS0000017570.V283864.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 and 16. Service users are provided with good standards of support to access appropriate community facilities and engage in appropriate activities. Their rights and responsibilities are suitably recognised. EVIDENCE: Both service users spoke about their ongoing attendance at a local day service. They attend according to individual needs, and receive transportation support from the home where needed. One service user spoke of the possibility of accessing another day service, based on an offer made at their last CPA meeting. Management fedback that they have involved other agencies to support one service user to undertake employment, but that this has ultimately not proved workable. Service users spoke positively about being provided with support to access the community where needed, such as for shopping, banking, and attending local recreational clubs. One service user noted that they have a freedom pass for free public transportation. Arrangements were seen to be in place to have the card 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 12 renewed. It was encouraging that the service user could ask to look after the renewal form and be entrusted to do so. One service user spoke of the holiday abroad that they are saving for. Both service users have been on individual holidays of their choosing in the last year. The service users confirmed that they can make and receive phone calls in the home. The home has a working payphone for social calls. One service user uses the phone regularly. One service user said that they have freedom here, and that they can get up and go to bed when they please. Staff spoke about service users having the choice of when to go to bed, and noted that one service user chooses to go to bed early. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 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 the following standard(s): 18, 19 and 20. Service users receive appropriate standards of personal care support where needed, and excellent standards of healthcare support. Standards of medication are generally good but one improvement is needed to ensure that appropriate records are maintained. EVIDENCE: Service users were seen to be reasonably dressed during the inspection. Discussions with management found that staff support service users to consider their appearance and make any clothing changes as needed. Individual plans and risk assessments considered the support that each service user needs with maintaining good standards of personal hygiene whilst maintaining independence and dignity. One service user spoke positively about the support provided in this area, whilst the other discussed with the inspector and staff about the need for these standards. Service users fedback that they receive good support to look after their health. Health records are up-to-date, very detailed and broad-ranging, in terms of standard preventative health care checks as well as such things as well-person clinic attendance and thyroid checks. Staff showed awareness of when a service user may be moving towards mental ill-health, risk assessments were in place for this, and one service user clearly stated that staff have this 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 14 awareness. They can, for instance, understand that at certain times things might be said that the service user does not mean. Health and social care professional feedback from comment cards all noted positively that staff show a clear understanding of service users’ needs, and that staff make appropriate decisions when they can no longer meet those needs. One service user confirmed that their medication is looked after fine by the home. It was observed that service users are given responsibility to ask for their medication. Consideration should given to looking at ways to increase this independence in a structured and risk-managed manner. Checks were made during the inspection of service users’ medications in stock against those recorded about. Medications are securely stored. They are provided from a pharmacy using the MDS blister-pack system. There were no concerns with stock control and appropriate administration except for one case of a PRN (as-needed) medication of one service user having been used but not having been signed for within the medication administration sheets. Checks with management found that the administration had been recorded about within the service user’s daily records. The manager must ensure that appropriate records are kept within the medication administration sheets. The requirements about medications from the last inspection, mainly about PRN (as-needed) medicines, were all found to have been addressed. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 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 the following standard(s): 22 and 23 The service has good standards of accepting and addressing concerns and complaints. Suitable systems are in place to prevent and address abuse. EVIDENCE: Both service users said that their views are listened to and acted on. One of them was seen to have a copy of the complaints procedure clearly available in their bedroom. Feedback from staff and management noted that both service users make comments and express opinions freely to them, and that issues are addressed where needed. Monthly service user meetings are held where issues may also be raised, and one staff member described how one such issue was raised by a service user. It was also noted that management are actively working on quality assurance systems that include service users’ views. Service users’ files include much auditing of their views in terms of likes and dislikes. The last complaint in the home’s complaints book dates from February 2004. None of the health and social care professionals noted within their comment cards that they have received a complaint about the home. The service users raised no issues about abuse or neglect. They stated that they feel safe in the home, and that they did not wish to move. Staff showed awareness of abuse issues and appropriate responses. There was certificated evidence of abuse awareness training for some staff on file, and the training officer confirmed that all staff working in this home have had such training. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 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 the following standard(s): 24 and 30. The home’s environment provides service users with good standards of comfort and cleanliness. A minor improvement is needed in respect of ensuring that the shower room’s heating works appropriately. EVIDENCE: The inspector found the home to be in a good state of repair, décor, and cleanliness from the start of the inspection. The heating was found to be reasonable. There was an electric heater additionally in the conservatory, to assist with the room being colder despite it also having a radiator. One service user noted that there was nothing in the home that needed fixing. The other service user raised issues about the shower room drainage system being ineffective, and that the radiator was not working. This was seen to be the case. The managing director consequently agreed to address these issues. The inspector noted that there is no outside light in the garden, for use when service users move between the conservatory and the adjacent cabin. Service users use this cabin for privacy and smoking purposes. Consideration should be given to installing a movement-triggered light in that garden area, to provide added security to the garden area. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 35. Service users are well supported by a qualified and competent staff team. The service provides staff with excellent standards of needs-led training. EVIDENCE: Both service users noted that there are enough staff working in the home. Rosters confirmed this. As noted under other standards in this report, staff have good knowledge of service users’ individual needs. Management and staff noted that there have been no staffing changes in the last year. There have therefore been no active changes to recruitment processes and practices. The standard is hence not assessed across this inspection year. The training manager spoke about the sustained training that is being planned. They have identified shortfalls in the training received so far, including with the development of staff who have undertaken NVQ courses. They are consequently planning to acquire training to address this, such as with CPA training. All staff have received mandatory courses such as emergency first-aid and fire safety training within recommended timescales. Staff are working towards, or have achieved, the NVQ level 3 in care. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 18 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 and 42. Service users benefit from excellent standards of management at this home. Health and safety matters are suitably addressed. EVIDENCE: The manager has extensive experience of residential care, and was a qualified nurse by profession. She has managed this home since it opened. The managing director is also extensively involved in the operations of the home. Staff fedback positively about the management style of the home. They confirmed that they receive appropriate support, and that they can air their views openly. The training officer confirmed that both the manager and the managing director have completed NVQ level-4 qualifications in management, and there was written evidence of this seen in one case. The training officer also noted that key management figures have had leadership and management training externally. One health professional noted within their comment card that the manager is very caring and competent. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 19 The accident book was found to contain reference to two falls that one service user has had since the last inspection. The service user has previously had occupational therapy input in respect of their needs, and the service user themselves confirmed that the room layout has been changed since the last fall, of three months ago, to minimise the risk of further reoccurrence. This is a suitable response in terms of health and safety. 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 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 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 4 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 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 2 X 4 X X X X 3 X 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 21 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 YA20 Regulation 13(2) Requirement The registered people must ensure that appropriate PRN administration records are kept within the medication administration sheets. The registered people must ensure that the radiator in the shower room is working whenever needed. Timescale for action 01/05/06 2 YA24 23(2)(p) 15/04/06 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 2 3 4 Refer to Standard YA7 YA20 YA24 YA24 Good Practice Recommendations It is recommended that the staff member involved in passing money onto the service user also signs the money records when the service users signs. Consideration should given to looking at ways to increase service users’ independence with medication in a structured and risk-managed manner. Consideration should be given to installing a movementtriggered light in the garden area next to the conservatory. Consideration should be given to making the drainage system in the shower room more effective. DS0000017570.V283864.R01.S.doc Version 5.1 Page 22 5 Courtenay Avenue Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 5 Courtenay Avenue DS0000017570.V283864.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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