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Inspection on 27/02/09 for 75-77 Wickstead Avenue

Also see our care home review for 75-77 Wickstead Avenue for more information

This inspection was carried out on 27th February 2009.

CSCI found this care home to be providing an Good service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 75-77 Wickstead Avenue 75-77 Wickstead Avenue Luton Bedfordshire LU4 9DW The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Roan Date: 2 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 75-77 Wickstead Avenue 75-77 Wickstead Avenue Luton Bedfordshire LU4 9DW 01582504217 F/P01582504217 H3082@mencap.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Mencap Society Name of registered manager (if applicable) Mrs Anita Meaton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: Mrs Meaton should complete her Registered Manager Award and NVQ 4 - Care, by 01 January 2006. Date of last inspection 1 6 0 2 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Five adults with learning disabilities live at the home. Mencap is the registered provider, while Aldwyck Housing Association owns the building. On the first floor there are five single bedrooms, two bathrooms and toilets and a sleep-in room for one member of staff. On the ground floor there are two lounges, an office, laundry facility, dining area and kitchen, and a large conservatory. Care Homes for Adults (18-65 years) Page 5 of 34 There is a well-maintained garden to the rear of the house. Two adjoining semi-detached houses had been converted into one property, which is not distinguishable from the other houses in the residential area of Luton where it is located. Shops and some local services are all within walking distance. Public transport into Luton town centre runs near the home. Care Homes for Adults (18-65 years) Page 6 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 34 How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced inspection, which took place in the late afternoon and evening. We selected two people who use the service to case track which involved reviewing the care they receive through review of their records, meeting with them and support workers. The inspection also took account of all information received since the date of the last visit and comment cards received. An annual service review was undertaken in March 2008, which did not change our view of the service provided. Care Homes for Adults (18-65 years) Page 8 of 34 A number of safeguarding referrals have been made over the past year. The staff team have managed these well and developed positive strategies in managing behaviours that challenge. They continue to work positively with funding authorities to find a resolution that meets the needs of people that use the service. Prospective users of the service are advised to contact the office to obtain up-to-date charges about fees. At the time of the inspection the Registered Manager was leaving to take up another position within the organisation. An acting manager has been appointed. Care Homes for Adults (18-65 years) Page 9 of 34 People using the service said I am supported to make my own decisions about what I do I can talk with a support worker if I am worried or not happy Support workers will assist me to make a complaint I am treated well by support staff I am very happy here I have my own room which I like I would like to have more staff so I can go out more often I am supported to do activities at a weekend Staff said We work with people using the service to be part of the community I have supervision once a month Access to training is good It gives me confidence in supporting the people at the home We are willing to improve and develop the service What the care home does well Wickstead Avenue is a comfortable and friendly home providing a service to people with complex needs. You will always be made welcome when visiting. Care Homes for Adults (18-65 years) Page 10 of 34 Bedrooms viewed were clean and pleasant and contained personal items. The service responds well when concerns are raised and manages challenges well. Support plans are created with people who use the service. People who use the service are involved with decisions about the home. Care Homes for Adults (18-65 years) Page 11 of 34 People using the service are supported to be as independent as possible. Support workers assist people in meeting their personal and health care needs. Your privacy will be was respected. Support workers are well trained and have good support. Care Homes for Adults (18-65 years) Page 12 of 34 The service is well managed. What has got better from the last inspection The service continues to improve the standard of support. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 13 of 34 If you want to speak to the inspector please contact Judith Roan 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 14 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People considering the service can be assured that a full assessment will be undertaken to ensure that their needs can be met. Evidence: The admission process ensures that full information is gained from the person requesting the service or their advocate, the funding authority and health care professionals. A copy of the Statement of Purpose and Service Users Guide are provided to ensure that detailed information is provided to help people in their choice. As part of the admissions process feedback is gained from all involved to ensure that the service can meet the persons needs. After which visits are planned to introduce the new person to the service and others who live at Wickstead Avenue. The AQAA states that the information available needs to be presented in friendlier way, an iaccessible format for people who use the service would be good improvement There has been one admission to the home since the last inspection and they Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: confirmed in their survey that they had been given information prior to moving into the home. In reviewing the care file evidence was found to confirm that a detailed assessment of need was undertaken and that people views were sought. This information is updated with ongoing work especially in relation to social and health care needs. Care Homes for Adults (18-65 years) Page 17 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using the service can expect that practices within the home promote their involvement and independence. Evidence: In case tracking two people using the service support plans were found to be in place. These are continuously updated to make them person centred and accessible for people using the service. It is evident that they are reviewed on a regular basis. The AQAA states that there are We have regular three way meeting between the person using the service, keyworker and manager to review their support plan. A further meeting is held with the facilitator for person centred planning and keyworker to review with the person that their plan is meeting their needs and states how they wish to be supported. In addition an annual review is undertaken with the funding authority. The main working file for each person using the service is intended to be owned by them and written in a user-friendly way. These gave a clear and overall picture of the needs of the person and how they were being met. These are supported by a main file that contains risk assessments and guidelines for support staff in Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: meeting their individual and complex needs. In observing people using the service their needs were seen to be met. In speaking with people who use the service they indicated that happy about living at Wickstead Avenue. This was also confirm in the surveys they completed with support to CSCI. Support plans seen contained strategies for support worker to minimise risks within relationships. These had been updated to take account of issues raised within the safeguarding referrals. CSCI was informed that staff were in discussion with funding authority about the placements at the home to enable people to be further protected. Risks within activities are considered on an individual basis and plans made to minimise these for each person. People using the service users are encouraged to be as independent as possible with appropriate support. In this way individuals are included within activities and not excluded because of any behaviour that may arise. Support worker were knowledgeable about the needs of people using the service. The key workers monthly reports provide a continuous update of assessed and planning information. In observation of practice within the home support was seen to enable people using the service to develop their skills and participate in everyday activities. Skills are achieved by the consistent approaches used by support workers. People using the service have access to a wide range of daily living activities. Care Homes for Adults (18-65 years) Page 19 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Planned intervention enables, respects individuals rights and supports people to develop personal skills and take opportunities for social and community activities. Evidence: Each person at the home has a plan of activities that include attendance at a day centre, college and leisure options. The activities provided the opportunity for individual development as well as leisure activities. Records of all recreational activities were maintained.Activities include going to parties, clubs, pubs and other leisure facilities. A planned holiday is also available. Activities do have to be planned and cannot always be spontaneous because of the level of support required by individuals. This was noted in surveys from people using the service and from staff. It was evident that support workers enabled people living at the home to maintain links with family and friends. Visitors would be were made welcome and people using Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: the service are supported to make phone calls and go out to visit their friends and family. People using the service said that they could choose what to do at the home and that daily routines are flexible to suit their preferences. Support plans recorded individual choices. Menus are prepared on a weekly basis in discussion with people using the service with the use of good visual choices. records show that meals are balanced and healthy. The menu can be changed to reflect personal choice or changes in the weather or activities. The evening meal served during this inspection appeared appetising and well presented, the dining area was congenial and people were generally relaxed. In discussion with people using the service and staff they felt that the quality of meals provided was good. Care Homes for Adults (18-65 years) Page 21 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A trained staff team ensures that people using the service are supported in meeting their health care needs. Evidence: People using the service users are supported to have regular health checks and there is evidence on files that GP, specialist, dentist and optician appointments are made. Personal support is provided in a discreet manner and with individual preferences being a top priority. The support plans are person centred and clearly state how people wish to be supported. Medical profiles have clear information about each persons health care needs. The files contained background information on specific medical conditions that aide support workers understanding of the health care needs of people using the service. All people living at the home are supported with medication as the risk would be high to self medicate. A good medication recording system is in place that demonstrates the path of medication coming into the home with safe administration and disposal. The home does not have a controlled drugs cabinet and this needs to be reviewed so that the Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: service would comply with the new regulation that came into force in 2007. All incidents are recorded on file to show how support workers have reviewed practice to minimise future risks. Case files seen have the necessary individual detailed plans that support their health care needs. Support workers were found to be fully aware of the details of these plans. The community learning disability health care team supports the service and provides support when required. Health actions have been completed for all people living at the home. Care Homes for Adults (18-65 years) Page 23 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using the service users are protected by policies and practices within the home. Evidence: Information provided in the AQAA and through notifications to CSCI the service shows that over the past twelve months there has been seven safeguarding incidents that required investigation. The manager states within the AQAA that Over the last 12 months we have improved the way in which we deal with safeguarding incidents. We ensure that people using the service are supported to raise concerns and complaints. Mencap has good formal policies and procedures relating to the making of complaints. Information is available in an accessible format. The good rapport that support workers have with those living at the home were seen during the inspection which enabled people to have their views listened too. Dealing with safeguarding incidents has given the staff team a renewed understanding of how important safeguarding procedures are. It is evident within care records that support workers have developed strategies in supporting people using the service to minimise the escalation of behaviours that are disruptive and place others at risk. Records show a significant reduction in incidents. The CSCI has not received any complaint since the last inspection. The services complaint procedure is available in a user-friendly format and available to all people using the service. In discussion with people using the service they said that if they had any worries or fears they would tell a support worker or the manager. All support Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: workers receive induction and foundation training, which includes training on the safeguarding of vulnerable adults. Recruitment processes also protect people using the service as records confirm that Mencap have robust checking procedures for references, criminal record disclosures and Protection of Vulnerable Adult checks. Care Homes for Adults (18-65 years) Page 25 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is maintained to a good standard, providing a warm and relaxed environment with good personal and communal space. Evidence: There are adequate rooms to enable everyone to have their own personal space in the large converted dwelling. People using the service were observed relaxing at in their home. Individual rooms are personalised, comfortable and well maintained. People using the service are supported in maintaining their rooms to a high standard of cleanliness and safety. The registered manager states in the AQAA that They review how the space is used with people who use the service and try to provide as much individual space as possible. We support people to have choice about daily cleaning and in the redecoration of the home. The home is well maintained and decorated to a good standard. There is a family size kitchen that is large enough for people to share their meals with support from staff. The communal space provides for individuals to undertake a range of activities within the house. A music room enables people to have personal time. One bathroom has been converted to a shower room to meet preferences of people using the service. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Records demonstrate that health and safety checks are undertaken with people using the service to maintain a safe home. Care Homes for Adults (18-65 years) Page 27 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The trained, competent and supported staff team ensure that the service is professional and meets identified needs of people using the service. Evidence: The staffing levels reflect the needs of people using the service. The staff team has been stable for sometime and provides consistent support within the service. Recruitment procedures are robust as files seen contained all of the required documentation to confirm that security and employment checks had been undertaken. References and Criminal record Bureau checks were in place. New support workers undertake an induction programme and work alongside experienced members of the team to gain full knowledge about the needs of people using the service living at the home. There is evidence of a good communication system within the home by the use of daily task list, the communication book, incident reporting and diary. Support workers are offered a range of opportunities to train. Three of the current staff team of eight hold National Vocational Qualifications (NVQ) at level two or above. Mencap is committed to an ongoing programme of NVQ training. Records confirm that mandatory training is undertaken and that support workers have good access to Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: ongoing training. Supervision is available with the manager meeting with staff on a regular basis. Staff surveys confirmed this fact. The staff team also meet to discuss development and dayto-day management issues. Mencap are introducing Continuous Professional Development and all staff are drawing together portfolios to evidence there training and ongoing development. This is in preparation for registration with the General Social Care Council guidelines. Care Homes for Adults (18-65 years) Page 29 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is effectively managed and ensures that people using the service receive a quality service where their views are respected and their safety is safeguarded. Evidence: The registered manager is moving to another position within the organisation and leaving soon. The deputy manager has applied for the manager post and been successful. There has been an opportunity to provide a handover in management responsibilities before the registered manager leaves. The registered manager has effectively managed the home in the best interests of people living at the home and the support workers. Mencap has a Continuous improvement framework that sets out how they promote and assure the quality of service to the people they support. Mencap promotes the use of person centred planning and actively seeking feedback from people who use the service and others involved with the service.The quality assurance system also includes a monthly monitoring visit at which time the continuous improvement plan is Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: reviewed and updated. People who use the service are regularly consulted on how the service can be improved, minutes from residents meetings demonstrate that the following areas are discussed- food shopping, holidays, activities, going out for meals, health and safety and fire training. Individual finances are recorded with two signatures and receipts. Health and safety policies and procedures were clear and accessible. Information provided within the pre inspection questionnaire confirmed that the appropriate health and safety checks and maintenance were undertaken. These records were seen at the inspection. Care Homes for Adults (18-65 years) Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 34 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 New regulations in relation to the storage of medication means that the service needs to ensure that they can comply if and when any person using the service has a controlled drug prescribed Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!