CARE HOME ADULTS 18-65
62 Second Avenue 62 Second Avenue Carlton Nottingham NG4 1GS Lead Inspector
Joanna Carrington Unannounced 1/6/05 10.00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 62 Second Avenue Address 62 second Avenue Carlton Nottingham NG4 1GS 0115 9117230 0115 9104267 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) NCHA CRH 4 4 Category(ies) of LD registration, with number of places 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 05/01/05 Brief Description of the Service: 62 Second Avenue is a home providing care and support for up to four adults with a learning disability. The home is a detached property within a residential area of Carlton, conveniently located for easy access to all community amenties. There is parking available at the front of the house for about three to four cars. The garden to the rear of the house is private and secure but requires some work in order for the area to be pleasant and attractive, for residents to use. All of the bedrooms are located on the first floor via a winding staircase. Therefore, the property is unsuitable for people with mobility problems. 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 7 hours on the 1st June 2005 and is the home’s first inspection for this financial / inspection year. The inspector was only able to speak with one resident, who was supported by a member of staff due to the residents having limited communication skills and understanding. Therefore, most of the judgements in this report are from observation and reading residents records and documents. Three residents files were looked at, one of which was for a resident who has moved to the home since the last inspection. A tour of the premises took place and staff records were also looked at. Two members of staff were spoken with and the manager was available for discussion and feedback throughout the majority of the inspection. What the service does well: What has improved since the last inspection?
Most of the issues that were identified at the last inspection have been tackled by the manager and staff so some significant progress has been made overall. The manager is still not registered but has now applied to the Commission for Social Care Inspection. Apart from one reference all other documentation has been received by CSCI. The next step will be an interview for registration. The manager has also applied to do her NVQ 4 Care and Managers Award,
62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 6 which without other relevant qualifications will be required. She is now waiting for a start date. Where there is no family involvement those residents have input from advocates and have been involved with looking at the contract / license agreement, as identified at the last inspection. The manager has now managed to obtain copies of references and Criminal Record Bureau checks for some staff that have to be held on the premises for the protection of the residents. The manager has now received some training on giving supervision sessions and with all staff receiving regular supervision and support, this is ultimately benefiting the people that live at the home. The kitchen has now been refurbished, with residents having some involvement in how it was decorated and the overdue electrical PAT testing has now been carried out. 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
62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 7 contacting your local CSCI office. 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 5 Prospective residents will only move to the home once their needs have been assessed. Although each resident has a copy the license agreement used is too general to apply to the people that live at Second Avenue. EVIDENCE: Of the three residents’ files that were seen all have an Extended Community Care Assessment which is the assessment that is completed by the relevant Community Learning Disability Team. The manager explained that this assessment is required before any prospective resident moves to the home and forms the basis for the care plan that is developed once the resident moves in. The license agreement / contract that is used is a general Nottingham Community Housing Association (NCHA) license agreement for all their housing provision. At previous inspections it has been highlighted that where there is no family involvement that these contracts are signed by an advocate. The manager explained that the advocacy service have legitimately refused to sign this contract because it does not take into account that residents may have challenging behaviour as a result of their learning disability nor does it refer to the specific service provision at the home. It was also explained by the manager that the Housing and Support Team with NCHA are looking at developing a more suitable license agreement. It is recommended that this
62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 10 include specific details on personal support, facilities and services provided, as outlined in Standard 5 of the National Minimum Standards. 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 and 10 Apart from a couple of gaps identified care plans and risk assessments are detailed and cover all aspects of residents’ lives, which help staff to meet their needs and also to promote their quality of life. Despite the limited communication and understanding staff do what they can to support and enable residents to make decisions and to participate in the day to day running of the home. Confidentiality is compromised due to the physical layout of the home. EVIDENCE: In accordance with NCHA policy information about residents should now be maintained electronically on their computer system. However, due to limited access to the computer for staff and also the difficulties posed for involving residents and representatives the home also operates its own system. There are handwritten copies available for each resident then this information is inputted onto the computer system mainly by the waking night staff. Although this system works for the home it does highlight a need to review the computer system in terms of its efficiency and access for both staff and residents etc. Two hard copies were looked at during the inspection. The care plans and risk assessments were comprehensive and provided clear information on how to
62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 12 meet the needs of residents. Individual preferences and likes and dislikes are included and how to respect residents’ privacy and dignity is also reflected incorporated. There are risk assessments to ensure the safe participation of chosen activities. For example, one resident enjoys climbing. The manager explained how when there is no family involvement an advocate is consulted in order to safeguard the rights of residents. When an advocate has seen and agreed with the implementation of a support plan evidence of this is required. There was a support plan for one resident who enjoys going out to the pub. Due to his medication this resident is permitted to drink alcohol. This restriction is included within the care plan but it is also recommended that a risk assessment is carried out identifying risks around drinking alcohol, and how these risks can be minimised. Although there were good support plans seen on how to manage individuals’ challenging behaviour there needs to be a more specific plan for at what stage of a resident’s behaviour that ‘when required’ medication is to be administered. As this is a form of restraint it is important that staff have very clear instructions so that a consistent approach is taken. Staff spoken with demonstrated awareness and understanding into the needs of the residents and how to effectively communicate with each of them. A member of staff spoken with explained how pictures and brochures are used to enable residents to make choices about meals and what activities to participate in. Colour charts were shown to residents when deciding what colour to paint the kitchen. There are residents meetings held every month and there are also notice boards in the kitchen and lounge informing residents through pictures and symbols of what activities are happening that day and what staff are on shift etc. While the office area is attached to the lounge by an open archway and entrance to the lounge is through the office, this means that staff have no where to discuss confidential information in private. 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13 and 17 Residents have opportunities to participate in appropriate activities and to access the community. Residents are offered a healthy diet and contribute to the planning of nutritious and varied meals. EVIDENCE: All of the residents attend appropriate day services during the week that offer person-centred and / or educational activities. These include cooking, walking, gardening, and aromatherapy. Staff spoken with were able to identify activities offered within the home that are both educational and that enable residents to develop skills. For example, music sessions, playing games, and helping with household chores. The manager described the home as being very ‘social’ and staff spoken with demonstrated a real commitment to supporting residents to access the community and having opportunities to go out. A resident spoken with said that enjoys going out to the pub. Later in the summer staff and residents will be holding a little fair outside the home to raise more money for the garden. Already people within the local community have been donating items for selling.
62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 14 Every Sunday evening a weekly menu plan is devised with the participation of the residents. A record is kept of what each individual has to eat and alternative options are provided for people who do not like the main meals that are on offer. Menu plans and records showed that nutritious, balance and varied meals are on offer with fresh fruit and vegetables provided. 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 19 Residents receive personal support in the way that is preferred and required and both emotional and physical health care needs of residents are met. EVIDENCE: The care plans seen make reference to individuals’ preferences as to how they like to receive personal support such as times residents like to get up and whether baths or showers are preferred. It is recommended that intimate care being provided by a person of the same gender is included within care plans as this was not included in a female’s support plan for supporting her during menstruation. Staff spoken with demonstrated an awareness of the healthcare needs of the residents and understood the importance of accessing specialist professionals to ensure that both physical and emotional needs are appropriately met. Clinical psychologists and psychiatrists with the Learning Disability Service are accessed and behavioural charts are filled in when there have been incidents, to assist in clinical reviews. It was also explained how one resident is supported in doing stretching exercises, as recommended by a physiotherapist and this need was clearly identified in their support plan. Residents’ weight is recorded monthly and there was evidence on files seen that residents have regular visits to the dentist, opticians and chiropody.
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The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Staff have a good understanding of the local Adult Protection procedures, which assures that the residents are protected from abuse. EVIDENCE: There have not been any recent allegations of abuse made by residents or any violent incidents between residents that have required notification to the Adult Protection Unit. However, from discussion with both the manager and staff it is apparent that there is a good understanding of the local Nottinghamshire Committee for the Protection of Vulnerable Adults (NCPVA) Policy and Procedures. Staff receive adult protection training as part of their induction and in addition to this some staff have also been on the NCPVA Adult Protection Unit’s training, which has helped staff to understand the procedures and how to ultimately safeguard the residents from any form of abuse. 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 28 Residents’ live in a homely environment although the physical layout of the home does compromise comfort while the office area remains as part of residents’ own communal space. Also to ensure a comfortable and homely environment there are parts of the home that are in need of redecorating. EVIDENCE: Overall the environment is homely and safe so long as people living at the home do not have mobility problems. However, the bathrooms are in need of redecorating as there are areas where paint is coming off the walls. The lounge area is reasonably spacious with large sofas for residents and staff to sit on. The problem is that access to the lounge is via the office and an open brick archway is the only thing that separates these two areas. Therefore, when staff need to work in the office and make phone calls this disturbs residents relaxation time and also compromises confidentiality (see Outcome for Standard 10). 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34 and 36 For the protection of residents some progress has been with a recruitment process that allows information about staff to be held on the home’s premises. Resident’s benefit from a well-supported staff team, that draws on their individual strengths and interests. EVIDENCE: It was evident from talking with staff that they are committed to providing quality care and support to the people that live at 62 Second Avenue. Individual staff are allocated different roles focusing on activities, quality assurance, vehicle safety and communication. This utilises individual strengths, enable staff to develop skills and take a lead in issues of interest. This benefits the residents and contributes to the efficient running of the home. Staff spoken with feel well supported and described the manager as being very approachable and fair but firm. The staff files seen indicate that formal supervision sessions are taking place regularly and since it was identified at a previous inspection the manager is now taking copies of references and Criminal Record Bureau checks for newly recruited staff. As outlined in Schedule 2 of the Care Home Regulations, for the protection of residents this information needs to be held at the home for all staff.
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The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 All of the necessary procedures and tests are carried out to promote and protect the health, welfare and safety of residents. EVIDENCE: At the last inspection an electrical PAT test was due. This has since taken place. There are good environmental and fire risk assessments and all of the necessary fire safety testing and checks have been carried and are up to date. For purposes of food hygiene fridge and freezer temperatures are recorded daily and cooked meats are probed at every meal. Water temperatures are recorded weekly for the prevention of Legionella. Staff are trained in all necessary health and safety practices such as food hygiene, infection Control, emergency first aid. The cupboard containing substances that are hazardous to health was secure and there are hazard data sheets available for all products used to ensure that any accidents involving these substances products can be dealt with and treated appropriately.
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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 3 x x 1 Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 4 2 2
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 1 x x x 1 x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x 3 x 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
62 Second Avenue Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6, 20 Regulation 12(1)(b), 13(6) Requirement To ensure the protection and welfare of residents and approprite administration of behaviour-managing PRN medication, a specific care plan is implemented for this. Ensure that when there has been consultation with an relative or an advocate that this is recorded and evidenced, (with signatures). To ensure that the needs of the residents can be met, the physical layout of the home must take into account how to safeguard confidentiality. This is an outstanding requirement from previous inspections, initial timescale 30/09/03. Ensure that adequate communal accomodation is provided for service users. While the office remains as part of this communal space then this is not adequate. This is an outstanding requirement from previous inspections, initial timescale 30/04/04. Ensure that all information as detailed in Schedule 2 of the Care Home Regulations is Timescale for action 30/06/05 2. 6 15(1) 30/07/05 3. 10 23(2)(a) 31/12/05 4. 24 23(2)(e) 31/12/05 5. 34 19(1)(b), Schedule 2 31/07/05 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 24 retained on site. 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 5 Good Practice Recommendations Develop a license agreement that is relevant to the needs of adults with a learning disability, that is more user friendly and follows the details included in Standard 5 of the National Minimum Standards. It is recommended that the electronic (SURE) system adopted by NCHA is reviewed in terms of access for staff and residents / representatives and the efficiency of the system, particularly in environments where there are adults with complex needs resulting in a large number of support plans and where there is only one computer for staff to share. Develop a risk assessment regarding alcohol intake for one resident. It is recommended that gender preference is referred to in care plans where intimate care is provided to residents. 2. 6 3. 4. 9 18 62 Second Avenue C53 C03 S8792 Second Avenue V230361 010605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Edgeley House Tottle Road Nottingham NG2 1RT Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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