Inspection on 29/09/05 for 5 Courtenay Avenue

This inspection was carried out on 29th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

5 Courtenay Avenue 30/05/07

5 Courtenay Avenue 15/02/06

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 29th September 2005 08:15 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 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.V254849.R01.S.doc Version 5.0 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.V254849.R01.S.doc Version 5.0 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.V254849.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th February 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 new 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 smoking shed within a good-sized garden. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across one morning in late September. It lasted until 12:55pm. The inspector discussed the services provided in the home with each service user. Feedback was also received from a couple of staff members and the managing director. The manager was attending a training course at the time of this inspection, and there were no other visitors. The inspection also involved the checking of some records and most of the home’s environment, and the observation of care practices. The inspector thanks all at the home for their patience and helpfulness throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: There were a few improvements necessary around the use of PRN (as-needed) medications, to ensure that service users receive what they are prescribed in this respect. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 Page 6 Whilst record keeping was in the main good, there were a few isolated areas where improvements are needed, most specifically with the handling of service users’ money by staff in respect of phone calls made by them. 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.V254849.R01.S.doc Version 5.0 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.V254849.R01.S.doc Version 5.0 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): None of these standards were assessed on this occasion as there have been no service user admissions since the last inspection. EVIDENCE: 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 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, 8, and 9. The service users are involved in the reviewing and updating of their individual plans, and so can be sure that their needs and goals are addressed within these documents. Risk assessments around service users’ individual needs must however be updated, to reflect current needs and hence minimise risks. Service users are consulted about, and can influence, how the home operates. They are enabled to make decisions about their lives in the home. EVIDENCE: The files of both service users were checked through. Recently-dated individual plans were in place for each service user. They tied in with recent CPA review meetings that the service users had signed. The plans contained brief details of the key needs of each service user and how staff would be expected to provide appropriate support. The risk assessments on file for the service users dated from the middle of, or late, 2004. Some of them related to activities that the service user no longer undertakes, such as with bath use for one person that should now be shower use. The assessments must be updated, to minimise current risks. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 Page 10 One service user clarified that they choose the times at which they get up and go to bed. They noted that they help to set the menu for the week, and that they choose when to eat. Records of service user meetings that are held monthly were found to be open and positive. The topics of discussion included about holidays and activities. One service user always chairs the meeting, with one staff member always present. The home looks after the money of one service user. The service user gets an agreed amount each day as part of a budgeting plan. Checks of the service user’s money records were found to be clear, had no discrepancies, and showed that the service user was able to acquire more of their money (beyond the budgeting plan) for specific reasons. The service user confirmed satisfaction with these systems. There was other evidence to suggest that whilst plans may be in place, sensible flexibility about their use happens in practice from both the service user and staff perspective. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 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, 14, 15, 16 and 17. Service users take part in appropriate community and home activities as per their individual needs and wishes. They are fully involved in making decisions about these activities. They are supported to uphold friend and family relations. Service users’ rights and responsibilities in the home are clear and enabled. Reasonable meals and diets are provided by the service. EVIDENCE: Both service users clearly explained to the inspector what their weekday routines are. Both said that they are happy with them. One service user noted that they see more family and friends with the recent changes to their routines, which suits them well. Both were also satisfied about the one or two days each week when they stay at home to undertake household and domestic tasks. One service user clarified that staff undertake most cleaning of the communal areas, whilst they are responsible for their bedroom. Checks of the service users’ daily records found that they attended day services, work placements, and clubs as per their activity plans. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 Page 12 Both service users were generally happy with the food provided in the home, and with staff organising it. The service users set the menus, and can choose alternative meals if needed. There was a reasonable amount of food in the kitchen, and a lot of food in storage areas, during this visit. One service user now has a flask to help them with taking drinks from the kitchen to their room. Both service users talked positively about their recent and separate holidays. One went to Spain with some service users from the organisation’s other home, and the other went to a holiday camp in Blackpool. Staff supported them on both holidays. It was clear, from service users’ and staff feedback, and from records, that service users are supported to stay in touch with family and friends, both through visits, letters, and phone calls. One service user noted that the payphone was difficult to manage, which the managing director agreed to address. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 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): 19 and 20. Service users’ health needs are met, but appropriate records of this must be consistently kept. Staff support service users to receive their prescribed medications. Some improvements are needed around the PRN (as needed) medication systems, to ensure that staff provide the correct support to service users. EVIDENCE: One service user’s records indicated that their health needs were being fully met. The other service user’s records lacked up-to-date information about routine health checks for the dentist and the chiropodist. The staff member present stated that the service user had, to her awareness, attended such appointments. The service user had gone out at this stage. Management must ensure that health summary records are kept suitably up-to-date for all service users. Neither of the service users self-medicate. The service users confirmed that they are happy with the system of being supported to take medication. Checks of the medication systems in place for the service users found no concerns in terms of the prescribed medications being given at the right times. It became apparent that there are some PRN (as needed) medications in the 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 Page 14 medication cupboard that are used by service users but which are not part of their written PRN plans. These medications need to be recorded about within the plan, or discarded at the pharmacist. Additionally, the plans involve calling management before dispensing some PRN medications. These directions should then be included in the plan. Finally, one service user had no stock of paracetamol as per their PRN guidelines and recently-signed administration sheets. Management must ensure that PRN medications that are used are kept in stock. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 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): Neither of these standards were inspected on this occasion. EVIDENCE: 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 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, 27, 28, and 30. The home is kept comfortable, clean, and pleasantly decorated. Redecoration throughout the main living areas has taken place since the last visit. There are washing and toileting facilities throughout the house, following the installation of an adapted shower facility downstairs late in 2004. EVIDENCE: The home has been significantly redecorated since the last inspection. This includes a new carpet, and redecorating of walls, throughout the hallways, stairs, and lounge. There are also covers on almost all of the radiators, which significantly reduces the risk of scalding accidents. It was noticeable from the start of this unannounced inspection that the home was clean and tidy. Both service users were happy with the environment of the home. The home is kept warm enough. One service user asked about the heating for the wooden out-house that both service users use for privacy. The managing director replied that a portable heater would be set up in there when the outside temperature drops. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 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 supported by a stable and competent staff team who receive regular training in key areas. Staffing levels are sufficient. EVIDENCE: The home has a training plan that aims to meet the national minimum standards, and to exceed it in some areas. The managing director stated that all staff working in the home will, or have achieved, NVQ level-3 or above in care. Written evidence for some of this was provided. The training files for staff were checked through. They contained a comprehensive amount of certificates, from which it was possible to deduce that each staff member has attended most applicable training courses. For instance, all have attended training in emergency 1st aid, and some have also attended training in moving and handling since the last inspection. It is recommended that an audit of necessary refresher training be undertaken for individual staff members. The roster for the previous week was checked through. There were no concerns about the staffing levels being used for the two service users. The service users had no concerns about the staff team, and reported that staff understand their needs. The staff team remains the same as at the last inspection. No agency staff are used. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 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): 38, 39, 41, 42 and 43. Service users benefit from clear staff communication and suitable management of the home. Their views, and those of stakeholders, influence how the home operates. Service users’ rights and interests are supported through good standards of record keeping in many areas, although there were a few exceptions to this. Service users’ safety is supported through appropriate health and safety systems. EVIDENCE: Management have undertaken a stakeholder (service users, their representatives, and professionals) audit of the quality of the services provided in the home. A sample of completed and detailed forms were seen. The managing director said that they have hired an independent person to visit the home a few times across the next few months to also check on all the working systems used within the home, and to report on the findings. This is a good standard of quality auditing, from which the services in the home should develop. A business plan for the year has also been previously developed, to 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 Page 19 help ensure the progression of the services. The organisation has also attained Investors in People staff support accreditation. Staff communication is greatly aided by a specifically-designed handover book that audits, for each shift changeover, such things as the money held on behalf of each service user, the cleaning that has been done, and what specific issues have arisen. Staff were seen to put up appropriate signs following the mopping of floors, which minimises risks to both service users. Professional checks for the gas systems and the portable electrical appliances were seen to be up-to-date. Regular staff checks of the water temperatures from hot taps, of the fridge and freezer, and of the fire equipment were recorded as in place. There have also been a couple of fire drills during 2005. It is recommended that these drills include the time of day, and the time taken for people to evacuate, so that any difficulties for individuals at certain times can be addressed. Staff and service users last received formal fire training in May 2004. The accident book found a number of entries relating to the service users. A sample of these were all found to have been cross-referenced into service users’ daily records, which helps with communication. The main trend from the records were seen to have been mostly addressed through the acquisition of new glasses for one service user. Staff were seen to keep appropriate records in many areas. For instance, it was recently recorded within one service user’s daily records that they locked themselves out of their room, and that staff used the spare key to help them regain access. One service user noted that they had paid staff small amounts for phone calls made in the home, for which the inspector found no records. The managing director investigated this, and agreed that records of such payments are needed. 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 4 X X 4 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 4 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 5 Courtenay Avenue Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score X 3 4 X 2 3 3 DS0000017570.V254849.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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. Standard Regulation Requirement It is necessary for service users’ risk assessments to be reviewed and updated in line with service users’ changing needs. (Previous timescale of 1/5/05 not met) 2 19 17(1)(a) schedule 3 Management must ensure that service users’ summary healthcare records are kept upto-date. To ensure that the history of allergies is recorded on the MAR. (Previous timescale of 1/3/05 not met) Where there are PRN (as needed) medications in the medication cupboard that are used by service users but which are not part of their written PRN plans, the medications need to be recorded about within the plan, or be discarded at the pharmacy. Management must ensure that PRN medications that are prescribed are kept in stock, and that any that run out are DS0000017570.V254849.R01.S.doc Timescale for action 1 9 13(4), 15(2) 15/11/05 10/11/05 3 20 13(2) 01/12/05 4 20 13(2) 10/11/05 5 20 13(2) 15/10/05 5 Courtenay Avenue Version 5.0 Page 22 promptly re-acquired. Management must ensure that, where staff take (or are given) any money from a service user for whatever reason, an appropriate record of this is made. 6 41 17(2) sch. 4 part 9 15/10/05 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 9 Good Practice Recommendations It is good practice to review, and if necessary update, service users’ risk assessments whenever their individual plans are updated (i.e. at least 6-monthly). The need for staff to call management before agreeing to dispense any PRN (as needed) medications to service users should be recorded about within the service user’s PRN plan. It is recommended that an audit of necessary refresher training be undertaken for individual staff members. It is recommended that the fire drill records include the time of day, and the time taken for people to evacuate, so that any difficulties for individuals at certain times can be addressed. 2 3 4 20 35 42 5 Courtenay Avenue DS0000017570.V254849.R01.S.doc Version 5.0 Page 23 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. 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