Inspection on 22/06/07 for 55 Amis Avenue

This inspection was carried out on 22nd June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

55 Amis Avenue 30/07/09

55 Amis Avenue 07/02/06

55 Amis Avenue 15/09/05

55 Amis Avenue 23/09/04

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Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 55 Amis Avenue 55 Amis Avenue New Haw Addlestone Surrey KT15 3ET Lead Inspector Pat Collins Unannounced Inspection 22nd June 2007 12:40 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 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 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 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. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 55 Amis Avenue Address 55 Amis Avenue New Haw Addlestone Surrey KT15 3ET 01932 350929 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) Welmede Housing Association Ltd Rachel Marie Flint Care Home 6 Category(ies) of Dementia (2), Learning disability (4) registration, with number of places 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be 30-65 years. The person to be accommodated in room 6 must be fully ambulant. Date of last inspection 7th February 2006 Brief Description of the Service: 55 Amis Avenue is a care home for adults with a primary condition of learning disabilities. People using this service are mixed gender and may have dementia, physical or sensory disabilities as secondary conditions. The home is operated and managed by Welmede Housing Association. Surrey Primary Care Trust employs the staff team. The property is a large, detached, single storey bungalow that has specialist adaptations and equipment to meet the home’s stated purpose and needs of people currently living in the home. It is domestic in scale and character and located in a residential area, central to the village of Woodham and near the town of Addlestone. Local shops and other community amenities are within walking distance. Bedroom accommodation is all single occupancy without en-suite facilities but includes washbasins. All areas including the garden are wheelchair accessible. Facilities include a spacious bathroom with adapted bath, a separate shower room and there are two toilets. There is a good size, combined lounge/dining room, which opens onto a small sun lounge and in turn, this, leads to a pretty, enclosed, garden. There is parking space for two or three cars at the front of the premises. Fee charges are £59, 415 per annum. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit undertaken by Pat Collins, Regulation Inspector, forms part of the key inspection process using the new ‘Inspecting for Better Lives’ (IBL) methodology. Judgements about the home’s conduct and standards of care are based on the cumulative assessment, knowledge and experience of the home’s service provision since its last full inspection in February 2006. This includes information supplied to the Commission for Social Care Inspection (CSCI) by the home manager. The visit commenced at 12:40hrs and concluded the same day at 17:20hrs. The registered manager was present for the last hour of the inspection and in her absence the deputy manager facilitated the inspection process. The inspector has looked at how well the home is meeting the national minumum standards set by the Government, and has formed judgements about standards of service provision at the home. A partial tour of the building took place and records and other documents were examined. Additional to discussions with the manager, deputy manager and a support worker, informal conversations took place with three people using the home’s services. All people using services were seen by the inspector during the course of the visit. Due to the degree of their disabilities, also communication difficulties, the main sources of evidence were the inspector’s direct observations of care practice and of interaction between staff and people using services; also information obtained from records and staff and feedback in questionarres received from two professionals and four relatives/representatives of people using services. The inspector also took account of information in questionairres completed by advocates on behalf of people using services, in consultation with them Judgements about welfare were also made on the basis of the appearance, body language, moods and behaviours of people using services. The inspector would like to thank all people living at 55 Amis Avenue, the home manager and staff for their hospitality and cooperation during the inspection visit. Also appreciation is extended to all who contributed information and to the deputy manager who worked after her shift had ended to ensure continuity of the inspection process. What the service does well: The home provides a comfortable, homely and stimulating environment that is suitably adapted to meet the specific current and future needs of the people who live there. The care support is person centred and staff are competent to meet needs, including more specialist needs and management of behaviours relating to deterioration in health, ageing process and dementia affecting individuals’ living at the home. The staff team is accomplished at ensuring social inclusion for all people using services, irrespective of the degree of their learning and other disabilities and health – related conditions. They enjoy a full 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 6 and varied programme of social and leisure activities reflecting individual needs, interests, natural abilities and choices. A relative commented, “ My relative (living in the home) has a social life which is better than mine”. Feedback from a health professional involved with the home confirms staff manages health needs and medication well. A second professional expressed the following opinion, “this is a very good all round service…the manager is very knowledgeable about dementia, current best practice, legislation and requirements and motivated and enthusiastic. This is reflected by the staff team, all of whom are committed to giving the best possible care and quality of life to the people using services”. Comments from relatives and advocates in questionnaires returned to the inspector demonstrated a high level of satisfaction with home’s management and operation and efforts of staff to ensure people using services enjoy a good quality of life. Examples were “ My son is very happy; everything is done to make him so”, “I like how each individual is catered for on their own likes and dislikes and requirements. This keeps a sense of recognition of who they are”, “ My relative’s care and interests are uppermost in staff’s thinking” and “ My relative is always dressed well and is obviously cared for very well, ALL his needs are met”. What has improved since the last inspection? What they could do better: The home has effective self - monitoring systems that are transparent in identifying areas for improvement. Staffing levels need to be increased in response to a significant change in dependency levels and a case is being made by the manager for this to be approved by the organisation’s senior management. Interim arrangements for supplementing existing care hours, whilst not a long-term solution, currently ensure appropriate and safe care and support. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 7 The current constraint on available management hours as a result of the high level of care and supports needs of individuals using services is a barrier to developments that the home’s management recognises to be necessary for improvement. It is intended to complete a more in depth quality audit system when time allows; also for work to take place on a range of documents producing these in formats more accessible for people using services. It is noted that the manager is in the process of changing the home’s vehicle for one that is wheelchair accessible, more suited to the needs of all people using services. 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. The summary of this inspection report can be made available in other formats on request. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 8 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 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: YA 1, 2 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People considering moving into the home and their representatives mostly have access to the information they need to enable an informed decision about the home’s suitability for meeting needs and aspirations. The manager intends to update information in the home’s statement of purpose and service users guide, using photographs and graphics to reflect current activities. It was agreed that additional charges not included in fees is to be available in the service users guide. Agreement to admission of prospective people using services is on the basis of comprehensive assessment of needs and aspirations carried out before admission to ensure these can be met. EVIDENCE: The home is operating in accordance with its stated purpose and within its conditions of registration. The manager confirmed the intention to update the statement of purpose and service users guide documents with photographs and pictorial/symbol information about current activities. A recent development has been acquisition of a computer and software package with graphics, scanner and CD writer. This is intended to be used to produce these and other documents, for example, minutes of meetings and reviews attended by people using services, person centred care plans, menus and activities programmes in formats that are even more accessible to people for which the home is intended. This will build on the good quality documentation currently available. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 10 Discussion took place with managers relating to the practice for people using services to purchase personal towels and flannels from their own money. It was understood these were not provided by the home though the manager clarified towels for communal use were supplied. It was suggested this standard practice should be reviewed to offer informed choice to people using services of purchasing their own towels or using the home’s supply. If it is the organisation’s policy not to include provision of towels for personal use this needs to be clearly specified in contracts and the service users guide. The manager’s attention was drawn to amendments to the Care Home’s Regulations in 2006 at the time of the visit. The need to include additional information in service users guides was discussed and agreed. The home has clear admissions criteria underpinned by an equal opportunities policy. There are five people currently accommodated, three men and two women whose ages range between 49 and 61 years. They moved in as a group at the time of the home’s registration in January 2006. Prior to this they lived in another care home operated by this organisation, which voluntarily closed on account of the unsuitability of the premises to continue to meet their changing needs. The staff team, including managers, transferred with them. It was positive to note the manager, occupational therapists, surveyors and builders had collaborated in the adaptation and furnishing of the environment, ensuring suitability to meet the needs of people using this service. People living in this home include individuals with complex health needs, sensory impairments, dementia and two individuals use wheelchairs at all times. It was good to note ongoing multi-disciplinary team input to the home providing professional specialist advice, assessment, support and staff training. This ensured the home’s continuing development and ongoing suitability the meet the changing needs of people using services. Prior to the home’s registration the manager had consulted people using this service, their key workers and relatives/representatives and advocates, involving them in decisions about moving home, choice of bedrooms, décor and furnishings. The transition programme was over four months and facilitated visits to the home by people using services and other stakeholders. Speech & language therapists were involved in creating objects of recognition programmes to assist people using services in finding their way around the building. People with dementia living at the home are under the umbrella of the dementia pathways/s.c.a.t.s. team who further assessed their needs and risks prior to moving home. Their orientation into their new environment was also closely monitored. Other risk assessments included moving and handling risk assessments carried out by a back care coordinator employed by Surrey Primary Care Trust. There have been no new admissions since the last inspection. At that time four pre-admission assessments were inspected and these found to be comprehensive and subject to regular review. Discussions with the deputy manager confirmed effort made to include prospective people using services in assessment processes and carer’s interests taken into account. Observations 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 11 confirmed assessments focused on achieving positive outcomes for people who use this service, ensuring the home’s facilities, staffing and specialist services are suitable and available to meet individual needs, including any ethnicity and diversity needs. On the day of the inspection visit there was one vacancy, which currently the home is unable to fill without adversely affecting quality of care without an increase in staffing levels. Further information about this is recorded in the Staffing section of this report. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 6, 7, 9 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Assessed needs and risks are addressed in care plans and effort made to illicit residents wishes to afford choices, where possible, in their daily lives. Care plans are comprehensive, clearly written and subject to regular review. The manager acknowledges some work needed for updating care plans with pictorial and graphic new information. Staff demonstrate good understanding of the needs and choices of people using services. EVIDENCE: People using this service have up to date care plans that have been formulated using a person centred approach. This means that people living in this home are valued as full members of society, have their rights respected and have opportunity to make choices in their daily lives and about their care and support; additionally their independence is promoted within individual levels of capacity and they are included in the local community. Person centred planning coordinators and facilitators have been involved in producing ‘user friendly format’ care plans. The staff team intends to further develop these with photographs and graphics to help people using services understand their care plans. Staff continues in use of objects of recognition and individual sensory work to support people using services in communicating needs, choices and 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 13 decisions. The manager stated the intention for staff to receive training in person centred planning. Two person centred plans (PCP) were examined and both included a current photograph of the person they belonged to and named their key workers. PCP’s have 5 sections including health action plans, communication, personal care, and individuality and community participation. Multi-disciplinary decision making processes were in place for any limitations on freedom, choice or facilities and underpinned by ‘best interest’ principles, involving relatives/advocates as appropriate. Daily care notes demonstrated support given to people using services to enable them to make informed decisions in their daily lives. Risk taking plans were in place though some were held in a separate file collectively for operational reasons. The manager agreed to the request for a copy of these to also be held on individual PCP files. Risk assessments were supported by clear guidance and risk management strategies. Both care plans sampled stipulated known likes and dislikes and contained information to assist staff in understanding individual ways for communicating wishes unique to individuals’ using services. The content of their care plans demonstrated respect for their privacy and dignity and addressed cultural backgrounds, spiritual needs, age, gender and sexuality. For example all people currently receiving services are White British (English) and are Church of England religious backgrounds. Staff enable those who wish to attend church to have opportunity to do so. People using services were stated to have chosen to eat a traditional English roast dinner on Sundays and like to visit relatives on this day. The addition of a further male staff member has enhanced management of diversity needs for the three men living at the home. They are best placed to support these individuals in trying on clothing in men’s clothing shops and visits to the barber. Female staff supports the ladies living in the home when they go to the local hairdressers and when trying on new clothing in shops. Also ensuring attention to their appearance, nails and provision of perfume. All people using this service were observed to have freedom to use all areas of the home including their bedrooms at any time within individual capabilities. . Without exception the feedback from relatives and advocates was positive about the care and support received by people using services. Examples of comments included “ Staff cater for the individual but also keep the family group together and it is good to see how they think of activities to keep residents occupied in the things they enjoy doing”, “ Everything staff are called on to do, they do, plus that bit extra”. The care plans sampled were generally up to date and subject to three monthly reviews or sooner as necessary. The manager is aware that some new information needs to be included in PCP’s but time constraints owing to the increasing needs of individual people using services is a current barrier to 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 14 carrying this out. Both the manager and deputy manager are part of the staffing levels and have no supernumerary time. The increase in dependency levels and significant change in needs of some people using services has reduced time that used to be allocated to management and administrative tasks. The team priority is the care and support of people using services. Administration and recording systems were noted to being gradually changed and developed when time allows. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: YA 12, 13, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People using services have complex needs and staff work hard to ensure appropriate stimulation is provided in and outside of the home. People using services are supported in maintaining relationships and in being part of their community. They are offered a diet that enables choice and meets dietary and other medical needs. EVIDENCE: The home’s ethos promotes independence and autonomy within the individual capabilities of people using services; also within a risk management frame work. Examples include free access of people using services to communal areas and their bedrooms and involvement in domestic routines and with gardening. A person using services lead the inspector out into the garden where he had previously being practicing with a tennis racket and ball and asked the inspector to join him in a game. He expressed being very happy with life at the home and said the staff “are all nice”. People using services have varied individualised activity programmes using leisure facilities, adult education services, therapeutic services, reflecting 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 16 abilities, interests and wishes Examples include cookery, rambling, bowling, pub lunches, performing arts/drama sessions, art, reflexology and individual sensory environment work. They are involved in shopping for food, clothing, and personal items, visit garden centres, playing bingo at the local community hall, go to the theatre, restaurants and cafes. People using services are also well supported in maintaining contact with relatives and friends. Comments from relatives/advocates in questionnaires confirmed their appreciation of staff’s efforts in transporting some individuals’ to visit family members and advocates at their homes. Comments included: “Staff drive my relative over to meet me at my daughter’s house”, “ Staff will bring my brother over to my house to see the rest of the family. They always remember family birthdays, Mother’s day and give presents”. Comments from relatives and advocates received included “ the home already does all I could wish for my son”, “staff try to give residents choices in everyday life and there are facilities to support their interests e.g. music systems etc” “Because of staff my relative seems to have had a happy and fulfilling life for which we can only be eternally grateful”. Relatives and advocates were also complimentary about communication arrangements that ensured they were informed of significant matters and involved in decisions as appropriate. People using services are assisted by staff in remembering special dates in family life and supported in sending cards on these dates. Social events are organised, examples of which are barbecues, birthday celebrations to which relatives, and advocates and friends are invited. There was an atmosphere of excitement in the home as staff prepared for a big party taking place at the weekend at a nearby suitable venue, to celebrate the fiftieth birthday of a person living in the home. His relatives were invited and many friends, past and present. People using services are enabled to maintain contact with friends from their time when they were in long-stay hospitals by attending a local ‘get together’ club, also at adult education centres and other social events. A person using services had a special interest in aeroplanes and showed the inspector his model plane, which he kept beside a framed photograph displayed in the lounge. This was of himself, staff and peers on holiday. When asked if he had gone on holiday on a plane he nodded indicating he did and smiled broadly when asked if he had enjoyed the experience. The manager confirmed the intention to provide a week’s holiday for three people using services over the next twelve months. None of the people using services have had a holiday since transferring to the home due to the need to orientate them into their new environment including the surrounding community. The people who will be offered a holiday, their keys workers and relatives/advocates are to be fully involved in decisions about the same. Also planned are more day trips this year to the coast and other places of interest. The manager stated the intention to further research suitability of other community facilities to extend choice of activities. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 17 The home is continuing to support people using its services in leading fulfilling lives and to be part of their local community through arrangements that enhance existing staffing levels. ‘Floating’ support workers, employed by Welmede Housing Association are used for care and support of people using this service who require 1:1 and 2:1 staffing ratios at times, enabling these individuals to continue use of community amenities and to maintain existing individualised activity and social care programmes. These workers also enable the team to meet the needs of others who are ageing and at time have need of 1:1 support enabling attendance at adult education classes. Individual sensory environment, reflexology and drama sessions have been arranged to take place in the home for people whose needs have changed and who prefer not to go out as much as they used to. These sessions are also available for others outside the home. The manager is hoping to change the house car for a vehicle suitably adapted for transporting two people who now use wheelchairs. This will enable continued access to community facilities enjoyed by these individuals. Observation made of food records confirmed ongoing provision of a varied diet catering for people with special dietary needs including diabetes; thyroid function imbalance and swallowing/eating difficulties. One person using services has been assessed by the feeding team at St Peters Hospital to ensure dietary needs continue to be met. Staff are following clear guidelines produced by a speech and language therapist when assisting this person with food. All weights are regularly monitored. The manager confirmed the intention to introduce a pictorial menu to assist people using services in choices of food. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 18, 19, 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service receive effective personal and healthcare support using a person centred approach and their physical, emotional and any diversity or cultural needs are met. The medication policy and procedures ensure the welfare of people using services and principles of respect, dignity and privacy are put into practice in meeting needs. EVIDENCE: Care plans contain a clear record of personal and healthcare needs detailed in health action plans, specifying how needs are to be met. Care and support is flexible and consistent, and with input from ‘floating’ support workers currently the home continues to respond and meet the changing needs of people using services. Discussion took place with management regarding the level of night care and support interventions needed on noting there is only one worker on the premises. The inspector was informed that this was subject to ongoing risk assessment and review but currently one staff member could safely provide the care and support required. Contingency arrangements are in place for on-call advice and support from managers and the home could access 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 19 assistance at night from a staff member on call, sleeping in at a care home in Ottershaw, if necessary. Records are maintained of contact with general practitioners who now undertake 3 monthly reviews in the home to support the home with staffing pressures. People using services are supported in accessing NHS health care generic and specialist services. Records examined confirmed contact with primary and specialist care teams, access to a podiatrist for four people and the manager stated some staff have had nail cutting training. There is input to individual health needs from ophthalmic services, specialist community dental service, orthopaedic service, community physiotherapy, occupational therapy services, speech and language therapist, wheelchair clinic and Dementia Pathways/S.C.A.T.S. team. The manager recognises the need for individuals to have risk assessments in place for pressure sore prevention and related care plans. It was stated that this has been identified and action in progress for these to be in place, and provision of pressure relieving mattresses and cushions in consultation with an occupational therapist. It was stated that the occupational therapist and back care coordinator had assessed specialist moving and handling requirements of individual people using services. Risk assessments for moving and handling and use of moving and handling equipment are in place and were sampled. Equipment includes low profiling beds with pentiflex mattresses, a new hoist with personalised slings, specially adapted chairs and 2 new wheelchairs. It was noted that the home had consulted an occupational therapist regarding the proposed purchase also of a standing hoist and a specialist hydro-tilt chair with special pressure relief technology to meet the needs of a named person using services. Discussion also took place regarding the need to be clear in the PCP of a person with a history of nocturnal seizures, though these are currently well controlled, about expectations for night supervision. The risk assessment in place has omitted to fully address this. It was good however to note a precaution to reduce risk of serious injury should this individual fall out of bed at night during a seizure, by reducing the bed height. It is acknowledged that a clear protocol and guidelines are in place for management of multiple seizures and for administering rectal emergency medication for this individual. Named staff were stated to have received training for administration of this medication and the manager confirmed that the District Nurse had been consulted regarding providing staff with refresher training. The management of medication was inspected and noted from previous inspection reports that the home has a sustained record of full compliance with statutory requirements for safe management of medication. None of the people using this service have capacity to self-administer medication. Medication is stored in a locked metal medication cupboard in the office. There is not a controlled drugs cupboard and at the time of the inspection no controlled drugs were prescribed. Records of receipt, administration and disposal were 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 20 maintained. Systems for supplying and collection of medication were efficient. Medication administration practice was not observed. Homely remedies are prescribed. All staff was stated to have received pharmacy medication training covering theory and practice followed by practice assessments. The manager stated that two staff were involved in medication administration procedures. Observations confirmed the privacy and dignity of people using services was respected and safeguarded by staff at all times in the delivery of intimate personal care. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 22, 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Effective complaint procedures are in place and mostly accessible to resident’ relatives and advocates. Procedures for safeguarding adults are robust enabling appropriate response to allegations or suspicions of abuse. EVIDENCE: The Commission for Social Care Inspection has received no concerns, complaints or allegations about this home since the last inspection. The home has not received any complaints and feedback from relatives/advocates in surveys returned to the inspector demonstrated commitment of staff to working in partnership with them aimed to ensure people using services are happy with their care and support and lifestyles. They were mostly in receipt of copies of the complaint procedure. One relative stated when a revised statement of purpose was sent to this person for information it referred to a complaint procedure being attached, which had not been sent. Procedures for responding to complaints and concerns are available in the home, though noted that the corporate procedure on file needed updating. This still refers to the former regulator also the content could be clearer that investigation of complaints is the responsibility of providers. A ‘User-friendly’ format has been produced to make the procedure more accessible for people using services. All staff have received training relating to John O’Brien’s five service accomplishments, which include promoting choice, dignity and respect for people using services. PCP’s include choices and preferences and these are followed to safeguard people using services from institutional abusive practices. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 22 The management of personal finances was routinely included as part of the inspection process. Observations confirmed secure systems for security of personal money belonging to people using services, supported by clear records of transaction and receipts for expenditure. Handover procedures include checking and verifying accuracy of money against these records and the manager confirmed accounts were externally audited from to time. Additionally periodical checks made of financial accounts by senior managers carrying out statutory visits on behalf of the organisation’s responsible individual. There had been no reported allegations or suspicions of abuse since the last inspection. The PCP (care planning files) sampled had social and specialist sections to address all behaviours that may make people using services vulnerable to abuse. All staff are required by their employer to attend annual safeguarding vulnerable adults refresher training session provided by Surrey County Council. The deputy manager reported pressure on places for most training events and some staff stated to be overdue this training, which was outside of their control. The deputy manager demonstrated good working knowledge of internal and multi-agency safeguarding procedures. Whistle blowing policies and procedures are in place. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 24, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the premises enables people who use this service to live in a safe, well-maintained, accessible and comfortable environment. EVIDENCE: The accommodation is a large, detached, modern bungalow on one level, which is wheelchair accessible throughout. All areas were clean and hygienic and odour control was excellent on the day of the inspection visit. Comment has been made earlier in this report on the positive impact of involving relevant professionals from the multi-disciplinary team and staff team, also people using services and their relatives and advocates in planning processes for adaptation, redecoration and refurbishment of the premises. Every effort has been made to ensure suitability of the environment to meet the needs of people currently living in the home. In addition to providing suitable equipment, for example adjustable height beds, walk in shower, a spacious bathroom for changing incontinence pads, bath and sling hoists, carpeting throughout the home has been carefully selected and walls painted 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 24 plain colours to ensure suitability for meeting needs of people with dementia. Sun reflecting tube lights have been added to darker areas of the home to enhance lighting and meet the needs of people with impaired eyesight. Care has been taken to ensure seating is at the correct height to meet individual needs. A small sun lounge overlooking the garden affords a second room where people using services can sit quietly or meet with visitors in private. Attention was drawn to the need to secure the loose handrail by the toilet in the bathroom and toilet cistern in the shower room. The manager agreed the necessary maintenance would be carried out. Bedrooms are all for single occupancy and nicely personalised, reflecting the personal tastes and interests of people using services. Furniture is of good quality and some have television, music systems, and DVD and Video players purchased by people using services for their personal use. A resident who is partially sighted was pleased to show the inspector his room. He had recently purchased a very large LCD plasma screen television which enabled him to sit comfortably in his chair to watch television without having to sit too close to the screen. He was obviously very proud of his new television and CD player and demonstrated how both worked to the inspector. He had a key to his bedroom and staff and other people living in the home respected his private space. Bathrooms and toilet facilities were observed to be hygienic, yellow bags containers had lids and storage of the same was satisfactory. All bathrooms and toilets had soap dispensers and paper towel holders though noted it was not the practice to use paper towels. Discussion took place with management about the importance of using paper towels for hand washing in communal toilets and bathrooms to reduce risk of cross infection. Staff were stated to have mandatory refresher training on infection control. Management confirmed that bathing facilities at the home were accessible to all people using services. The pretty, secluded garden to the rear of the home was secure. It was tidy and colourful shrubs and potted plants created a pleasant environment for the enjoyment of people using services and their visitors. There is a small patio with table and chairs. The manager stated that staff had plans to develop a sensory garden, which can be appreciated by people with sensory disabilities. They would like to include a water feature and wind chimes to add sound to the sensory experience. A huge conifer has recently been removed and there are plans to renovate this area with new borders with plants at a suitable height to be enjoyed by wheelchair users. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 31, 32, 33, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Interim arrangements are in place for supplementing staffing levels, providing additional care hours to enable staff to respond to the changing needs of people using services and ensure a higher level of care and support. The manager has submitted a case of need for additional staffing. Currently priority is being given to meeting needs which utilises time that was previously available for management and administration tasks. People using services are safeguarded by the home’s staff recruitment and training practices. EVIDENCE: The staff group is well established most having worked with the people using this service for a number of years and transferred with them from their former care home. Staff are employees of Surrey Primary Care Trust who provide training to ensure their ongoing development and provision of mandatory training. Since the last inspection there was a four month period when the team was depleted by the long term absence of the deputy manager and transfer of a staff member to another care home. The manager reported improvement since the deputy manager resumed work and a senior support worker transferred to the team from another home. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 26 The staff records sampled confirmed that staffing levels are being enhanced by at specific times by ‘three floating support worker’ hours (employees of Wemede Housing Association) for meeting the substantial increase in needs of individuals’ using services. The staffing establishment has not changed and staffing levels continue to be two staff for most of the waking day which includes the manager and deputy manager, who have no supernumary time allocated for management and administration work, and 1 waking staff member on night duty. Interim arrangements to meet higher care and support needs provide betweeen 15 to 50 hours care each week providing extra cover during busy periods. This enables people using services who now need staffing ratios of 2:1 and 1:1 at times, to continue using adult education facilities and following other leisure pursuits in the community. Quality and continuity of care is being maintained by use of a pool of regular bank staff with the requisit knowledge and skills. The manager provides an extra member of staff on shift as necessary to facilitate medical and other appointments to take place and at times to provide extra support when people using services are unwell. The manager was noted to be preparing a submission of a case for increasing the home’s staffing establishment to senior management. Current arrangements, whilst meeting needs are not a long term solution as this is not ideal for continuity of care, offers no capacity for admission to the home’s vacancy and create pressure on management time. Professional support for the case being made for an increase in staffing levels was noted which is considered necessary in order to maintain current levels of care and support, to enable outings and community activities and acces to medical appointments for all people using services. Areas of discussion with management included safety of night staffing levels. Both confirmed this was subject to risk assessments and continous monitoring and review. It was stated that currently one night worker could safely manage the needs of people using services at night including moving and handling and pressure area care. Thee was an out of hours, on – call arrangement for advice from a manager and night contingency arrangements in the event of needing assistance by way of calling in a staff member sleeping in at another care home in the area. It was stated that currently all people using services slept well once settled for the night. Personnel records were securely stored. There had been no new staff employed since the last inspection therefore personnel records were not sampled on this occasion. At the time of the last inspection recruitment policy and procedures overall were in compliance with statutory requirements. The manager confirmed that the home now held evidence of staff’s Criminal Record Bureau disclosures and checks against the the list of people unsuitable to work with vulnerable adults, operated under the Protection of Vulnerable Adults Scheme. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 27 Opportunity was limited for discussions with staff other than the manager and deputy manager during the inspection visit. In a brief conversation with a support worker it was evident he had a good understanding of his job description, role and responsibilities and of the needs of people using services. Observation was made of his warm and friendly approach in his interaction with people living at the home. Staff receive mandatory and service specific training and training records were sampled. Staff’s training and development needs are identified through appraisal and personal developments processes or as needs arise during supervision. There is a rolling programme of refresher training though the deputy manager advised this was sometimes oversubscribed resulting in updates being overdue for some staff. The training programme also includes dementia care, epilepsy awareness, objects of recognition, individual sensory environment work, and on the Mental Capacity Act. There is a NVQ programme and 71 of care staff was stated to have NVQ qualifications in care, independent living and care management. Some staff have NVQ level 3 promoting independence and NVQ level 3 in management, leadership and empowerment in organisations. Other training includes health and safety, fire safety, infection control, moving and handling, anti-discriminatory practices, food safety, data protection, risk assessment for manager and care standards modules 1 to 10. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 37, 38, 39, 42, 43 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager has relevant qualifications and experience and is registered by the Commission for Social Care Inspection. The home has a consistent record of compliance with relevant health and safety requirements and despite competing pressures on management time is efficiently and effectively managed. This is evidently through the hard work of managers and team commitment to ensuring the home runs in the best interest of people using services. The ethos, leadership and management approach benefits people using services and quality assurance systems are inclusive and effective. EVIDENCE: The manager is registered by CSCI and has 15 years experience of managing care homes for people with learning disabilities. The manager is suitably qualified which includes appropriate management qualifications and the Registered Manager’s Award and has extensive, relevant knowledge, skills and experience. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 29 The deputy manager also has relevant qualifications and experience and is currently working towards NVQ Level 4 qualification in care and management; thereafter she stated her intention to study for the Registered Managers Award qualification. The home’s management structure includes senior support workers and the manager and deputy manager are included in staffing levels. The manager was present for part of the inspection visit and in her absence the deputy manager competently facilitated the inspection process. The impression was formed of a cohesive senior team providing good direction and leadership to staff and of good teamwork. Observations confirmed the management of the home was efficient despite constraints and competing pressures on management time. This was evidently achieved through the extra efforts of managers and the team as a whole. They ensured day – to – day management and administration tasks were completed without detriment to the quality of care and support to people using services. Managers were conscious that the higher care and support needs of individual people using services had depleted time available and used in the past for the home’s management, administration and continous development. Discussions with managers confirmed the impact of competing demands on their time was a barrier to plans for improving recording systems, developing documentation for this to be more accessible to people for whom the home is intended, to staff training and development and reviews and other meetings, also to devising the home’s annual development plan. Managers were concerned that staff supervision and appraisal targets may not be met in the future and about delays in implementing Welmede Housing Association’s improved quality assurance systems which needed discussion within the team. Without an increase in staffing levels managers’ feel there is potential for this to adversely impact on the quality of care, specifically, on continuing the same level of access to community leisure and adult education pursuits that enable people using services to lead fulfilling lives. The current staffing pressures are also a constraint to admissions to the home’s vacancy. Communication systems in the home are effective and monthly staff meetings attended by all staff and handover periods’ support the same. Quality Assurance systems were noted to include a recent survey of relatives and advocates of people using services and of involved professionals. An independent advocate supported people using services, able to do, in responding to survey questions. Monthly visits, which included audits, are carried out unannounced by senior managers from Surrey Primary Care Trust, People with Learning Disabilities Services and Welmede Housing Association, in rotation. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 30 Systems and records sampled for administering personal finances of people using services are underpinned by risk assessments, with appropriate checks and balances. Welmede Housing Association was stated to carry out financial audits and financial records were periodically checked at times of monthly statutory visits, by senior management. Policies and procedures were evidenced to be updated on a regular basis and weekly health and safety audits and fire safety audits carried out by staff. A programme of regular cleaning, maintenance and repair was evident. Areas of discussion with the manager included the need to replace the employer’s liability certificate displayed, which had expired, with a new certificate. The manager stated this was available electronically and this would be done. It was also noted and discussed with the deputy manager that the loft used for archiving records had been found to contain asbestos in the lining and access to this area now restricted. Records examined in this matter stated this constituted a low risk hazard to people using services and was a risk only if the area was disturbed. It was understood that the denied access to archived records did not pose operation difficulties for the home. Discussion also took place regarding shortage of storage space inside the home for storage of essential equipment, for example two wheelchairs, a sling hoist and standing hoist that is soon to be acquired. This is a domestic scale property and whilst currently this equipment can be stored safely in vacant bedroom when this place is filled this may pose an issue for safety in the environment. Managers were clearly conscious of the need to ensure moving and handling safety in bedrooms and all areas and importance of not overcrowding bedrooms and maintaining corridors and fire exits clear at all times. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 31 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 4 2 4 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 4 23 4 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 x x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 x 4 4 4 x x 4 3 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 32 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. Standard Regulation Requirement Timescale for action 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 YA1 Good Practice Recommendations For the statement of purpose and service users guide to be further developed and updated with photographs and pictorial information about current activities. The service users guide must incorporate additional information in accordance with the revised care homes regulations and include details of charges exclusive of fees. In addition to the master file of risk assessments maintained for operational purposes, for these risk assessments to also be held on individual care files. For care plans to be further developed including new information and in a style and format accessible to people using services. For the home to change the house car for a wheelchair accessible vehicle. For pressure sore risk assessments to be regularly undertaken as appropriate and where indicated by risk assessment scores for pressure sore prevention plans to be generated. DS0000061399.V338967.R01.S.doc Version 5.2 Page 33 2. 3. 4. 5. YA6 YA6 YA13 YA19 55 Amis Avenue 6. YA19 7. 8. 9. 10. 11. YA22 YA24 YA30 YA33 YA37 12. 13. 14. YA42 YA43 YA43 For the risk assessment for a person using services with a past history of nocturnal seizures to address night monitoring needs and if necessary for this to be clearly specified in a care plan. To ensure the organisation’s complaint procedure in the home is current. If this is this case for this to be updated. For repairs to be carried out to the loose handgrip frame round the toilet in the bathroom and to secure the toilet cistern to the wall in the shower room. For improvement to infection control procedures by provision of paper towels in communal toilets. For the home’s establishment to be increased enabling an increase in staffing levels. For the manager to have at least one shift a week when she is supernumerary to staffing levels to focus on management and administration tasks and development activities. For storage of equipment to be reviewed in the context of how this will be managed safely following an admission to the vacant bedroom, currently used for this purpose. For a current employers and public liability insurance certificate to be displayed. For an annual development plan to be in place for the home. 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 55 Amis Avenue DS0000061399.V338967.R01.S.doc Version 5.2 Page 35 - 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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