Inspection on 25/10/05 for 62 Second Avenue

This inspection was carried out on 25th October 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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

62 Second Avenue 23/10/08

62 Second Avenue 25/04/07

62 Second Avenue 27/06/06

62 Second Avenue 01/06/05

62 Second Avenue 05/01/05

62 Second Avenue 14/07/04

62 Second Avenue 04/02/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Second Avenue, 62 Care Home Carlton Nottingham NG4 1GS Lead Inspector Joanna Carrington Unannounced Inspection 25th October 2005 09:30 Second Avenue, 62 Care Home DS0000008792.V253217.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 Second Avenue, 62 Care Home DS0000008792.V253217.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. Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Second Avenue, 62 Care Home Address Carlton Nottingham NG4 1GS 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) 0115 9117230 0115 910 4267 NCHA Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 01/10/05 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. Second Avenue, 62 Care Home DS0000008792.V253217.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 over four and a half hours on the 25th October 2005. This was the home’s second unannounced inspection for this inspection / financial year. The main method of inspection was called ‘case tracking’ which involved selecting two residents and tracking the care and support they receive through the checking of their records, discussion with care staff and observation of care practices. Due to the profound learning disability and subsequent limited communication and understanding of the residents the inspector was unable to speak with them, other than some brief interaction with one resident. This inspection concentrated on following up requirements set at the last inspection and inspecting the remaining key standards. This report, therefore needs to be read in conjunction with the previous report. What the service does well: The service does well at presenting support plans and risk assessments. They are detailed and provide the necessary information for meeting the needs of residents and promoting their quality of life. Support plans for one resident in particular are of an excellent standard and it is recommended that this quality is extended to other residents. Staff do well at supporting residents to maintain contact and relationships with family and friends and there are a number of systems in place, some of which are being developed, for monitoring and reviewing the quality of care. The home is kept clean and hygienic, which is important for promoting the health of residents. Training opportunities for staff are good, which ensures that staff are equipped to meeting the needs of residents. Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Second Avenue, 62 Care Home DS0000008792.V253217.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 Second Avenue, 62 Care Home DS0000008792.V253217.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): 5 Work is still outstanding on developing a license agreement that is applicable to the residents living at the home. EVIDENCE: It was explained at the last inspection that the Housing and Support Team of Nottingham Community Housing Association will be developing a license agreement that is suitable to the needs of residents with a learning disability / displaying challenging behaviour. The current license agreement used is a general one, which an advocate legitimately refused to sign on behalf of residents at Second Avenue. The recommendation still stands that the contract includes all items as specified in Standard 5 of the National Minimum Standards. Second Avenue, 62 Care Home DS0000008792.V253217.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 and 9 Care plans are detailed and enable staff to meet the needs of residents. Confidentiality is compromised due to the physical layout of the home. EVIDENCE: The requirements to devise a risk assessment for one resident’s alcohol consumption and a support plan specifying when a resident’s ‘when required’ medication is administered have now been addressed. Like all of the other support plans for residents, these provide all of the relevant information necessary to meet the needs of residents and to promote their quality of life. There are risk assessments to ensure the safe participation of chosen activities. For example, one resident enjoys climbing. It is recommended that all residents care plans aspire to the support plans for one named resident, as these were excellently detailed, covered all areas of need and addressed their rights. Relatives are consulted over support plans and for one resident who has no relatives there has been consultation with an advocate, who has agreed to the support plans. This is good practice. Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 10 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 nowhere to discuss confidential information in private. At the last inspection a new timescale was set for an outstanding requirement to address this problem. This requirement has not yet reached its timescale therefore remains as a requirement in this report . Second Avenue, 62 Care Home DS0000008792.V253217.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): 15 and 16 Residents are appropriately supported to maintain relationships with family and friends. Residents’ rights and responsibilities are recognised and respected but more documentation in care plans for this is required. EVIDENCE: Both members of staff spoken with were able to see how important it is for individual residents’ to maintain contact with their families and friends. Examples were given of how residents are supported in this such as facilitating phone calls and transporting residents on visits to see family, and this was reflected in respective resident’s support plans. In August a fete was held at the home to raise money for the garden. Staff explained how this created another opportunity for residents to meet with family and friends. Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 12 The majority of the support plans seen make reference to how each individual’s privacy and dignity is to be maintained and it was evident from discussion with staff and from observation that residents are treated with dignity and respect. One of the resident’s has a support plan specifically for privacy and dignity, which is good practice. There also needs to be information recorded as to why individuals’ do not possess or use a key to their bedroom. Some residents may be able to use a key with some support. If not then a support plan needs to state how the security of residents’ possessions can therefore be safeguarded. Staff spoken with explained how residents are involved in some housekeeping tasks such as wiping tables, laundry and cleaning bedrooms, for which there is a rota. It is recommended that individual residents’ have a support plan for domestic and daily living skills, which specifies what tasks individuals are responsible for. Second Avenue, 62 Care Home DS0000008792.V253217.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): 20 Residents are protected by the home’s policies and procedures for dealing with medicines, however, staff must ensure that medication is counted in properly and the amount correlates with records. EVIDENCE: A monitored dosage system is used at the home and all staff are trained and assessed before having any responsibilities for administering medication. There are photos of residents held with the Medication Administration Records (MAR), which promotes the safety of residents. MAR records seen were in order, and provided clear instructions for the administration of medication. No errors for administration of medication were found. Staff must ensure that medication is always counted in and recorded on the MAR sheet. The number of tablets remaining for some controlled medication did not tally with the quantity and amount administered as recorded on the MAR chart. Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 14 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): X Neither of these standards were assessed on this occasion EVIDENCE: Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 15 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, 28 and 30 Improvements to décor has helped to ensure that residents live in a comfortable and homely environment, however some more internal repairs are required and the physical layout of the home does compromise confidentiality and impacts negatively on residents’ communal space. The home is clean and hygienic. EVIDENCE: Since the last inspection the bathrooms have been redecorated. Residents were involved in choosing colours. Some other repair work to a damaged door and its frame is required. This has already been reported to Maintenance and is awaiting repair. On a tour of the premises it was evident that the place is kept clean and tidy. There is a list of daily, weekly and monthly chores that staff refer to in order to ensure that all necessary cleaning jobs are done. It is recommended that the Environmental Health Authority are consulted over contingency arrangements for sluicing as there is neither a facility on the washing machine nor available sinks in the laundry area. Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 16 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. A new timescale was set at the last inspection for an outstanding requirement, to address this problem. Therefore, the requirement remains in this report. Second Avenue, 62 Care Home DS0000008792.V253217.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): 34 and 35 All staff records must be available for inspection in order to assess whether residents are protected by the recruitment policy and practices. Residents benefit from an appropriately trained staff team . EVIDENCE: The manager is taking photocopies of references and Criminal Record Bureau disclosures for newly recruited staff before this information is then sent back to employment services where all personnel information is held centrally, which is policy of the Nottinghamshire Healthcare Trust and Nottingham Community Housing Association. If documentation for all staff, as specified in Schedule 4 of the Care Home Regulations are not being held at the care home then there needs to be internal arrangements in place to ensure that these records are made available for inspection on the day of the inspection. Staff spoken with confirmed that they are happy with the level of training they receive. Currently training can be accessed from both the Nottinghamshire Healthcare Trust and Nottingham Community Housing Association. The Assistant Manager has devised a training file to assist in identifying training needs of staff. As well as mandatory training such as Infection Control, Moving and Handling and First Aid there are courses on Risk Assessments, Autism Awareness, Epilepsy Awareness, Computer Training, Spiritual Needs, all courses that are valuable for staff to carry out their support role. Second Avenue, 62 Care Home DS0000008792.V253217.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): 39 and 41 There are systems in place for monitoring and reviewing the quality of care that aim to be underpinned by the views of residents. So that the Commission can effectively regulate care services the manager must ensure that incidents in accordance with Regulation 37 are notified to the Commission. EVIDENCE: Nottingham Community Housing Association (NCHA) has a number of systems for monitoring the quality of care. There are regular internal audits that use staff and residents from other services and also external audits. There are feedback surveys used to obtain the views of residents, which staff fill in on residents behalf. New ways of collecting information is currently being looked at. There are also residents meetings held every month. The home is signed up to the Nottinghamshire initiative ‘The Quality Tree’ that promotes quality assurance based on the involvement of residents. The manager has received training on how to implement this. Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 19 The assistant manager mentioned an incident concerning two residents that resulted in a notification to the Adult Protection Unit. In accordance with Regulation 37 and so that issues of adult protection in care homes can be closely monitored this incident should have also been notified to the Commission. Second Avenue, 62 Care Home DS0000008792.V253217.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 2 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 1 Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X X X 1 X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score x X X 1 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Second Avenue, 62 Care Home Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X 3 X 2 X x DS0000008792.V253217.R01.S.doc Version 5.0 Page 21 No 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 YA5 Regulation 5(1)(c) Requirement Develop a standard form of contract for the provision of service and facilities by the registered provider to service users; that is more applicable to the needs of residents with a learning disability. 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 there are adequate arrangements in place for the safe recording, handling and safe keeping of medicines received into the home. 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. When records as specified in DS0000008792.V253217.R01.S.doc Timescale for action 28/02/05 2. YA10 23(2)(a) 31/12/05 3. YA20 13(2) 30/11/05 4. YA28 23(2)(e) 31/12/05 5. YA34 17(2)(3) 31/12/05 Page 22 Second Avenue, 62 Care Home Version 5.0 6. YA41 37 Schedule 4 are not maintained in the care home then there must be internal arrangments in place to ensure that these records are made available at the care home on the day of inspection. Ensure all incidents as specified in Regulation 37 are notified to the Commission. 30/11/05 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 YA16 Good Practice Recommendations Specify on support plans for the promotion of Privacy and Dignity when service users do not have their own keys or how they can be supported, if this is their choice, to use a key. Risk assess how the security of residents’ possessions can be safeguarded. Ensure all residents have a support plan specifying what household tasks they have some responsibilities for. 2. YA16 Second Avenue, 62 Care Home DS0000008792.V253217.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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