CARE HOME ADULTS 18-65
71 Middleton Avenue Stockton-on-Tees TS17 0HG Lead Inspector
Stephen Smith Unannounced Inspection 2nd February 2006 09:30 71 Middleton Avenue DS0000000013.V272811.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 71 Middleton Avenue DS0000000013.V272811.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. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 71 Middleton Avenue Address Stockton-on-Tees TS17 0HG 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) 01642 750617 H4037@mencap.org.uk Royal Mencap Society Mrs Christine Anne Lambert Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of persons shall not at any one time exceed 6 people with learning difficulty 7th June 2005 Date of last inspection Brief Description of the Service: 71 Middleton Avenue is registered with the Commission for Social Care Inspection under the Care Standards Act 2000 as a care home providing care and accommodation for up to 6 adults who have a learning disability in spacious single rooms. The home is a purpose built bungalow and is situated in a residential area near a sports field. The home has been established since 1993 and is located within a short bus journey of local facilities such as shops and a leisure centre. The home provides spacious accommodation and is suitable for wheelchair users. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was the second inspection of the home since April 2005. It was carried by one inspector in three and a half hours. The purpose of the inspection was to inspect the home in terms of the key National Minimum Standards not covered at the last inspection. During the visit the inspector spoke to the manager and three staff members. It was not possible to consult the residents in depth but the inspector observed their interactions with staff members and spoke to them informally. A tour of the premises was undertaken and records examined including training records, residents’ plans of care and maintenance and fire records. What the service does well: What has improved since the last inspection?
The home has done most of the things that it was asked to do after that last inspection. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 6 It has made sure that information about the qualifications that staff have has been added to its statement of purpose and it has put information about the Commission for Social Care Inspection and the last inspection report into the resident’s guide. A lot of work has been done outside the home to make it more secure and to stop people who shouldn’t getting into its grounds. It has got more work planned. A lot of work has been done to put right some of the decoration and maintenance problems that were seen at the last inspection. New bathroom flooring is going to be fitted soon and this work will make the inside of the home even better for the residents to live in. The home has arranged for someone to spend a lot of time finding out from residents and their families what they think about the home including what is good and what they could do better. It is good that this has been done in a way that has allowed the residents to have their views properly heard. 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.
71 Middleton Avenue DS0000000013.V272811.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 71 Middleton Avenue DS0000000013.V272811.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): The standards relating to Choice of Home were not assessed at this inspection. EVIDENCE: Although these standards were not assessed, consideration was given as to whether two requirements and a recommendation made at the last inspection had been addressed by the home. A requirement relating to the home’s statement of purpose had been fully actioned by the home. A requirement relating to residents’ contracts and a recommendation regarding the service user guide had been partially addressed. 71 Middleton Avenue DS0000000013.V272811.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 and 9 Residents are supported and encouraged to make as many decisions about their lives as is possible for them. The home is good at assessing and managing risks to enable residents enjoy a fulfilling and independent lifestyle. EVIDENCE: The significant communication difficulties experienced by residents means that seeking their views and opinions is extremely difficult but it was evident from discussion with staff, the manager and from examination of care plans that staff know residents and their needs and preferences very well. Detailed information is in place in plans of care about residents’ communication needs, preferences and decision making ability. Plans contained detailed guidance for staff about how to assist the resident concerned and daily recording showed how and why decisions were made on residents’ behalf. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 10 Records showed great many examples of individualised care and activities planned and carried out based on residents’ specific needs. Residents’ families are consulted about decisions where the resident needs additional support and evidence showed that the home keeps families well informed about the wellbeing of their family member. As residents are unable to take part in conventional residents’ meetings an Opinions Book is maintained containing information about residents’ likes, wishes and requests. This book contained information about how these opinions were sought and records showed that requests made or preferences identified are responded to in planned activities and support. Residents’ plans of care contained very detailed and specific risk assessments that are clearly linked to the care plan so that care need, preference regarding how help is delivered and any associated risk are stored together and clearly interrelated. Risk assessments viewed were structured in such a way as to identify and manage risks in such a ways as to promote the resident’s ability to take part in the activity and to promote their independence. A new format of risk assessment is being developed to promote enablement even more. Risk assessments observed were regularly updated with changes being recorded where situations had changed or progressed. Files contained a summary sheet listing the areas for which risk assessments are in place for easy reference for staff members. Risk assessments views had been signed by residents’ family members to indicate their agreement and signatures were in place whenever assessments had been updated. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 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): 16 and 17 The home is good at respecting and promoting residents’ rights in their daily lives. Residents receive a healthy diet that allows them choices about what they eat and when. EVIDENCE: The residents’ care plans examined contained a evidence to show that the home makes great efforts to promote individual’s ability to make their own decisions and the routine of the home is based around the activities, preferences and needs of residents. The home’s risk assessment process is very thorough and provides a clear explanation of the reasons for restricting residents from activities on the basis of risk. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 12 Observation during the inspection showed that staff members are very aware of the dignity of residents and treat them very respectfully; staff knocked on residents’ doors and responded promptly to requests for assistance. The manager and staff members cited examples of residents being empowered to make their own decisions, chair their own meetings and to make a complaint about a service provided to them outside the home. Post had arrived for residents whilst they were out of the home, on their return a staff member went to support them to read the contents of the letters. Interactions between staff and residents were seen to be extremely positive. Staff members spend a great deal of time talking to residents and identifying their wishes and needs and make sure that activities or events are based on residents’ individual preferences. The use of the Opinions Book is very helpful in making sure that residents’ opinions, ideas and likes and dislikes are identified. The home provides residents with a choice of menu and works with them to promote a healthy diet. A provisional planned menu is in place but this allows flexibility for special events, residents’ routines, activities and preferences. Residents’ diets are monitored by staff in daily records with information being passed on to ensure that people are eating well and their diet is varied. Specific plans are put in place for residents if they have specific needs that require a close monitoring of diet. Detailed plans are in place in residents’ files regarding how they want and need to be helped at mealtimes and any risks attached. Residents’ preferences and tastes are clearly recorded. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 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): 18 and 19 Residents get good help from staff in a way that they like and that meets their needs, their health needs are met well. EVIDENCE: Care plans examined contained a lot of information about residents’ preferences about how they like their personal care to be provided. All care plan areas link preferences care needs and any risks together and this was clearly the case with the provision of personal care. The home has suitable equipment for the needs of the residents and staff members receive training in using any aids. Moving and assisting training is provided to staff. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 14 As residents are unable to be fully consulted about their personal care, relatives agree care plans on their behalf, nevertheless the home goes to great lengths by observation, non verbal communication and discussion with residents to make sure that all assistance is delivered in a way that they like. Advocates are involved in the home to help seek residents’ views and to help them have a voice in matters relating to them. Routines in the home and residents’ individual routines are clearly based on their own needs and preferences and staff members spoken to were very aware of the sorts of things that residents like and choose to do. Residents’ care plans contained a lot of information about their health needs and the support or treatment needed. Correspondence, and records as well as daily recording showed that the home is very involved in seeking good health carer for the residents and works closely with health professionals to achieve this. Records showed close links with professionals in relation to people’s physical, emotional and mental health and discussion with staff members and the manager showed that staff are very aware of residents’ health needs. Staff members spoken to told of a situation in which a resident had been assisted to make a complaint about a poor health service received and how she had been enabled to chair and be central to the resulting meetings to discuss the complaint. During the inspection a resident came back to the home from a medical appointment that he had clearly not enjoyed very much. Staff members arranged for him to go out for lunch to help him relax. A requirement made at the last inspection, that the home must follow its own medication procedure, was examined and it was found that this requirement had been addressed. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The home has an effective complaints procedure and takes the views of resident and their families very seriously. EVIDENCE: The home has a complaints procedure in place that meets the requirements of Regulation 22 of the Care Homes Regulations 2001. All family members have a copy of this procedure on behalf of their relative at the home and information about the complaints procedure is included in the service users’ guide. The manager said that other professionals who have contact with the home have been given a copy of this procedure, as do those who work with the residents in other settings. The home has a recording system in place to record any complaints received along with the action taken to investigate, the outcome and whether or not the complaint was substantiated. No complaints had been recorded in this record and the manager said that the home has not received a complaint. Advocates are used in the home to support the residents and help them express their views and the manager told the inspector of a situation in which a resident had been enabled by the home to make a complaint about a health service received. The visits made by the home’s registered provider under Regulation 26 of the Care Homes Regulations 2001 include monitoring the complaint records. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 16 A requirement made at the last inspection that the home must improve its external security arrangements has been actioned by the home and is to receive further attention. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 17 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): The standards relating to the home’s Environment were not assessed at this inspection. EVIDENCE: Although these standards were not assessed at this inspection consideration was given as to whether a requirement made at the last inspection had been addressed by the home. A requirement that the home rectify a number of décor and maintenance issues had been addressed. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 Residents benefit from being supported by a staff team that are competent well trained and very focussed on their individual needs and wishes. EVIDENCE: Observation during the inspection showed that staff are extremely resident focussed. Staff members spent a lot of time talking to residents with respect, in such a way as to promote their dignity and to make sure that their needs are being met. 70 of the care staff team have either NVQ2 or NVQ3 in Care and training is provided to all staff on an ongoing basis. The staff on duty at the time of the inspection demonstrated an appropriate mix of qualifications and experience. Staff training includes all necessary mandatory the needs of the resident group. Training working with people who challenge, autism manager and staff said that training can be specific issues or situations faced by residents. training and training based on undertaken recently includes and dual diagnosis and the requested in relation to any 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 19 The home operates an induction and foundation training programme that is in line with Skills for Care requirements and a staff member recently employed had finished the induction programme and was working on the foundation. The manager said, and records confirmed, that individual training needs profiles are developed in staff supervision sessions in November. These profiles identify mandatory training and then any training needed for by the service or individual staff member. A workforce training and development plans is developed form these individual profiles and training provided in line with this plan. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 20 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): 42 The home’s environment and working practices protect and promote the safety and welfare of the residents. EVIDENCE: The home has aids to assist the moving and assisting of residents; these had been recently maintained and staff members have received training in moving and assisting people. Examination of fire records showed that the home’s fire alarm, fire fighting equipment and emergency lighting are all service regularly and checked by staff on a weekly basis. Fire drills take place regularly with clear records being maintained of the names of staff members and residents taking part and the outcome of the drill and fire training is provided regularly. The home has a fire risk assessment in place; the fire officer last visited in January 2006. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 21 Staff members have all received training in first aid, the manager said that some staff will need refresher training this year and that this has already been requested. All staff members have training in basic food hygiene. Induction training covers health and safety issues and risk assessments relating to the premises and its equipment are in place. Records of the servicing and maintenance of the home’s electrical and gas installations showed that all required checks are carried out within the necessary timescale and were up-to-date at the time of the inspection visit. At the last inspection a requirement was made that the home develop a quality assurance system involving consultation with residents and their families. Since this inspection a great deal of consultation has taken place involving meetings with residents and families. A report of the outcome of this consultation has not yet been produced, however, and such a report must be produced and supplied to the Commission for Social Care Inspection and residents families. A recommendation was made at the last inspection regarding the manager’s need to achieve NVQ4 in Management and Care. The manager is ongoing with this training; she should complete this qualification by 2007. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 22 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 X 2 X 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 3 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X X X X X X 3 X 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 23 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. 1 Standard YA39 Regulation 24 Requirement The home must produce a report based on the quality assurance exercise that is being undertaken and supply this report to the Commission for Social Care Inspection and residents or their families. Timescale for action 07/04/06 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 Refer to Standard YA1 YA5 YA37 Good Practice Recommendations The Service Users Guide should be in a format that service users can understand. Service users’ contracts should be signed by the service user or their representative. The manager should continue to work toward achieving NVQ Level 4 in care and management, or equivalent, by 2007. 71 Middleton Avenue DS0000000013.V272811.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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