Inspection on 10/01/06 for 7 to 9 Third Avenue

This inspection was carried out on 10th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

7 to 9 Third Avenue 05/12/06

7 to 9 Third Avenue 02/03/05

7 to 9 Third Avenue 02/09/04

7 to 9 Third Avenue 10/03/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Third Avenue (7/9) 7/9 Third Avenue Wickford Essex SS11 8RF Lead Inspector Mrs Bernadette Little Unannounced Inspection 10th January 2006 10:15 Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Third Avenue (7/9) Address 7/9 Third Avenue Wickford Essex SS11 8RF 01268 571865 01268 571865 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) Estuary Housing Association Limited Mrs Penny Luxton Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th August 2005 Brief Description of the Service: 7 and 9 Third Avenue are two purpose-built semi-detached bungalows with an interconnecting door, located in a quiet residential area of Shotgate, and within walking distance of the local shops. Care and accommodation is provided for six adults with profound learning and physical disabilities. The home provides accommodation in single bedrooms and there are specially adapted bathrooms and toilets. Each bungalow has independent facilities, number 7 has a lounge/ diner and a separate kitchen, while number 9 has an open kitchen/dining and lounge area. The front of the house has parking space and an attractive garden and is in keeping with other houses in the street. There is a secure rear garden, which has been designed with the residents in mind and has scented plants and water features. The home has a minibus to assist residents to attend leisure and social facilities in the community. The home also has a mobile sensory unit, which can either be used by residents in the communal areas or in the privacy of their own room. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second routine unannounced inspection of 7-9 Third Avenue this year. It took place over a four-hour period on a Tuesday. Time was spent with seven of the eight residents. The registered manager assisted with the inspection throughout. Four staff were spoken with. Records and documents were looked at, as were all parts of the home, except one bedroom, where a resident was resting. The help and hospitality given by the residents, staff and manager were appreciated. What the service does well: What has improved since the last inspection? What they could do better: The records about the occasional medicine given to residents, and the medicine they should be given, needed to be looked at again so they are both the same. Some of the bedrooms were not very warm even though the heating was on. Sometimes the water temperatures were not very warm. The home needs to do more to get this working properly. Please contact the provider for advice of actions taken in response to this Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 The information contained in the Statement of Purpose and Service User Guide would enable prospective service users and their supporters to assess the capability of the home to meet their needs. EVIDENCE: The registered manager advised that the Statement of Purpose and Service User Guide had been reviewed and updated in October 2005. Copies had again not been received by the Commission. There had been no new admissions since the last inspection. Appropriate policies and procedures were in place. Some training has taken place regarding service user specific conditions, for example dementia, introduction to mental health and positive responses training. Evidence was seen of planned training for staff in Understanding Learning Disabilities and also on the Role of the Support Worker. Training on issues such as autism and sensory impairment remain outstanding. A record was maintained of the charge to each resident and this was noted in their statement of terms and conditions. The registered manager advised that residents do not pay any additional charges. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Residents’ were appropriately supported to exercise choices and control over their lives according to their abilities and needs. EVIDENCE: The residents at Third Avenue do not have clear verbal communication. Observation of practice and discussion with staff demonstrated that support workers endeavour to consult with residents, to try to establish their views and respect their decisions and to take appropriate risks. Examples of this included allowing a resident to ‘ lead’ staff, with appropriate professional health care support, in the resident’s own pace of rehabilitation following an accident. There is a clear policy of procedure for staff in relation to respecting the confidentiality of information about residents. Discussion with staff indicated their awareness of good practice. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 10 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): 11, 12, 13, 14,16 Staff supported residents to take part in meaningful activities to the best of their ability. EVIDENCE: Staff spoken with were able to clearly indicate how residents were helped to develop their skills and abilities, for example in making hot drinks for themselves, supported by appropriate risk assessments. Residents had limited presence in the community, but where possible did go for example to the pub and to the theatre. The registered manager advised that they were trying to improve this, and recent attendances at community over 50s clubs had been surprisingly successful. Some residents also attended church services regularly. Residents had regular sessions at the hydro-pool. Four residents attended Wickford Exchange, where they accessed the community and also participated in activities such as arts and crafts and sports facilities. Necessary additional staffing is being negotiated for one resident following closure of their day resource to ensure appropriate support for leisure and community activities. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 11 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, 21 Some aspects of medication practices need attention to ensure residents wellbeing. EVIDENCE: Records were maintained of medication received and returned. There were clear policies and procedures in place. The manager advised that all staff had up-to-date medication training, although no evidence was available to support this. Some omissions were noted on the medication administration records. Rectal diazepam had been administered to one resident on the morning of this inspection. The date of administration was inaccurate on the record. A protocol was in place for this ‘as required’ (PRN) medication. For clearly explained reasons, the protocol was not being accurately followed in the dosages of medication administered. The registered manager was advised to contact the consultant psychiatrist without delay and have the protocol reviewed as appropriate. The protocol did not identify which staff had been trained to administer this medication to the specific resident. There was no clear evidence available of staff training and assessment of competence for staff, including the agency staff involved. This needs to be addressed. It was noted positively that a resident file contained clear information on the familys wishes for wishes and practices at the end of life. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 12 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): 23 The home’s practices and procedures, along with staff training, protected residents. EVIDENCE: Estuary had detailed policies and procedures in place on protecting vulnerable adults and whistleblowing. Staff spoken with demonstrated appropriate awareness. The registered manager and staff spoken with confirmed that permanent staff had had recent training on this issue. Records of training for agency staff indicated that they had all attended this training. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 13 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, 25, 26, 27, 28, 29, 30 7-9 Third Avenue gave the residents an attractive and homely place to live. The comfort of residents could be enhanced by a more effective heating system. EVIDENCE: The premises was generally found to be maintained to a very high standard of décor and furnishing. Some rooms were noted to feel cold and the temperature of 58° was recorded in one resident’s bedroom, although the heating was on. The recorded temperatures of some of the hot water outlets were also noted to be low in some areas. Staff confirmed that there had been ongoing issues with the heating system. More effective monitoring and action is needed to address this. A risk assessment had been undertaken by Estuarys health and safety representative regarding the outward opening toilet and bathroom doors. The registered manager was recommended to use signs on the doors to identify the potential hazard. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 14 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): 33, 34, 35 The home continued to make good efforts to provide safe and consistent care for residents through it’s staff team. EVIDENCE: The registered manager confirmed that additional staffing is being accessed to support an individual resident following the closure of their day resource. This is considered particularly necessary in light of the advised increase in residents needed over the 13 year period the home has been open, without a corresponding increase in staffing levels. Efforts to recruit permanent staff continued and one staff is awaiting references and checks before starting work. In the interim, Estuary had negotiated to contract six specific agency staff to work consistently at the home. They will be managed and supervised by the home’s manager and included with permanent staff in any training. It was noted positively that photographs were available of permanent staff and all regular agency staff. Recruitment records will therefore be considered at the next inspection. The manager was advised that confirmation should be sought from the agency that all appropriate checks and references were in place prior to a first shift working at the home. A training plan and matrix was in place. This indicated that staff have completed all basic mandatory training, including fire training, with the exception of moving in handling training which is overdue, but booked. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 15 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 40, 41, 42 The manager was well supported by a committed staff group to provide person centred care. EVIDENCE: Staff spoken with confirmed that the manager is approachable and supportive. Discussion with staff and observation of practice indicated that 7-9 Third Avenue was run with residents’ wellbeing as its first consideration. Estuary’s corporate policies and procedures were sampled. They were readily available in the office and had been signed and dated by the registered manager. Some, but not all staff had signed to say they had read the medication policy. Records of residents’ money sampled were satisfactory. Current safety inspection certificates were available for the gas supply, fixed electrical wiring, fire alarm, emergency lighting, fire equipment and mobile hoist. Water temperatures and fire alarms, emergency lighting and equipment were recorded as checked regularly. The manager was advised to monitor the record of fire drills to ensure that all staff were included regularly. Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 16 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 2 2 X 3 X 4 2 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 2 14 2 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 3 X 3 X 3 3 2 X Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 17 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 YA1 Regulation 4&5 Requirement The person registered must send a copy of the amended Statement of Purpose and Service User Guide to the Commission. The person registered must ensure that staff employed at a care home received suitable training to the work they are to perform. This refers to resident specific training for example in autism, sensory impairment. (Previous timescale of 01/10/05 not met). The person registered must ensure that residents have adequate opportunity for community presence and leisure pastimes with adequate staffing support levels. The person registered must ensure safe administration and recording of medication. The person registered must ensure adequate heating and water temperatures for residents. Timescale for action 01/02/06 2. YA4 18(1a)& (C)(i) 01/03/06 3. YA13YA14 16(2) m&n 01/03/06 4. 5. YA20 YA24 13(2) 23(2)p 10/01/06 10/01/06 Third Avenue (7/9) DS0000018078.V277334.R01.S.doc Version 5.1 Page 18 6. YA34 17(2)Sch4 (6) 7. YA35 18(1)c(i) 13(5) 8. YA42 23(4) (e) The person registered must 10/01/06 maintain in the care home all the records required for all staff, including agency staff. (Carried to the next inspection) The person registered must 01/02/06 ensure training for staff in moving and handling and ensure that evidence of all staff training/qualifications is available for inspection. The person registered must 01/02/06 ensure that all staff regularly participate in fire drills/ practices. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA1 YA24 YA32 YA33 Good Practice Recommendations Copies of the amended and updated Statement of Purpose and Service User Guide to be sent to the commission. (Outstanding from the last inspection). The hazard of the outward opening toilet and bathroom doors should be clearly identified in each case. 50 of all care staff working at a care home should achieve NVQ training. The person registered should continue to undertake a review of the care staffing levels at the home, and prepare and instigate appropriate increased staffing levels to meet residents’ needs as soon as the current day-care facilities are withdrawn. (Carried to the next inspection as implementation currently awaited) The manager should obtain confirmation from the agency that all appropriate checks and references were in place prior to each person’s first shift working at the home. 5. 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