Inspection on 05/10/06 for 9 Roseland Avenue

This inspection was carried out on 5th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

9 Roseland Avenue 10/10/08

9 Roseland Avenue 05/12/05

9 Roseland Avenue 25/08/05

9 Roseland Avenue 28/09/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Roseland Avenue (9) 9 Roseland Avenue Devizes Wiltshire SN10 3AR Lead Inspector Malcolm Kippax Key Unannounced Inspection 5th October 2006 12:20 Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 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 Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 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. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roseland Avenue (9) Address 9 Roseland Avenue Devizes Wiltshire SN10 3AR 01380 728507 01672 569477 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) Cornerstones (UK) Ltd Mrs Lisa Cheryl Harridine Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1), Physical disability (1) of places Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated in the home at any one time is 6. Only the one, named, female service user between the ages of 18 and 64 years with a physical disability referred to in the application dated 5 October 2003 may be accommodated in the home and this person must be accommodated on the ground floor. The home may only accommodate one person with a learning disability aged 65 years and over. Any placement for short-term care or for an emergency placement must be agreed with the Commission before the placement commences. For the purpose of this condition, short-term is defined as a placement that is expected to last not longer than 3 months. An emergency admission is defined as an admission whereby someone is likely to be placed at short notice without an up-to-date assessment of needs having been carried out and the person has not had the opportunity to visit the home prior to placement. 5th December 2005 3. 4. Date of last inspection Brief Description of the Service: 9 Roseland Avenue is in a residential area close to the centre of Devizes. 9 Roseland Avenue is one of a number of care homes in Wiltshire that are run by Cornerstones (UK) Ltd. The home provides care and accommodation to up to six people. Each service user has their own bedroom. One of these is on the ground floor and the others are on the first floor. One service user has their own en-suite bathroom. The other service users use a bathroom on the first floor. There are separate toilets on the ground and first floors. The communal rooms consist of a lounge and a conservatory type extension that is used as a dining area. There is a domestic type kitchen. At the rear of the house there is a garden, a garage and a parking area. The home’s records are kept in a small office. There is another room on the first floor that staff use when they are sleeping-in. Service users receive support from the home’s manager and deputy manager and a team of five support workers. The weekly fee at the time of the inspection was £765 per person. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home, which took place on 5 October 2006 between 12.20 pm and 5.45 pm. A second visit was arranged with the home’s manager in order to complete the inspection. This took place on 19 October 2006 between 9.45 am and 2.10 pm. There were six service users living at the home at the time of this inspection. Evidence was obtained during the visits through: • • • • Discussion with the service users, two relatives, staff members and the manager. Observation. A tour of the home. Examination of some of the home’s records, including three service users’ personal files. Other information has been received and taken into account as part of the inspection: • • • • The manager completed a pre-inspection questionnaire about the home. The service users, with support from the manager and staff, completed surveys about what it is like to live at 9 Roseland Avenue. Comments were received from two local authority care managers. Three of the service users’ relatives completed comment cards. The judgements contained in this report have been made from the evidence gathered during the inspection, including the visits to the home. What the service does well: The service users have lived together for a number of years and have well established routines. Details of their day to day needs are well recorded in individual plans, so that staff have the information they need when providing support. Service users are supported with making decisions and encouraged to make their preferences known. They choose what meals they would like and how they wish to spend their time. Some decisions have been recorded as personal goals, which set out what service users would like to do and receive support with in the future. It was evident from talking to service users that their interests and activities are well reflected in the personal goals. There were also examples where the service users’ goals reflected their specific needs as older people. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 6 The home’s approach to risk assessment benefits service users by helping them to be independent within their capabilities. When risk assessments are carried out, they are well referenced within the service users’ individual plans. The service users’ rights are respected, subject to some agreed restrictions being in place for safety reasons. Service users receive support with family relationships and with their friendships in the home. Service users have individual lifestyles and their bedrooms reflect their different interests. They enjoy some regular activities outside the home. Socially, the service users have varied pastimes and tend to keep to their own routines. However they are encouraged to meet together to discuss things that affect them and to share any concerns with staff. Staff members receive training and guidance, which helps to protect service users from abuse. There is a varied menu and service users enjoy their meals. Service users need some assistance with personal care and with managing their healthcare and medication. Arrangements are made, which help to ensure that service users have their needs met and that they are supported in a safe way. Service users receive good continuity of support from the manager and staff team. The staff team know the service users well and service users benefit from staff members who are developing their skills and receiving regular training. The home is being well managed for the benefit of service users. Improvements are identified through the organisation’ system of quality assurance. Overall, the accommodation is meeting the service users’ needs and there are good arrangements being made for their welfare and safety. What has improved since the last inspection? Service users have talked to staff about activities and things they would like to do in the future. This has resulted in some new personal goals being agreed. Information has been recorded about how service users can best be supported in order to achieve these goals. There have been some improvements to the environment. A new floor covering has been fitted between the kitchen and the lounge. Externally, the grounds have been tidied up and some unwanted items removed. One of the staff members said that training had improved in recent years. It was seen from home’s training plan that new courses and training events are being arranged and made available to staff. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 7 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. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not looked at on this occasion. No new service users have moved into the home for a number of years. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 10 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, 7 and 9 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. The service users’ needs and personal goals are very well reflected in their individual support plans, which help staff to provide consistent support. Service users benefit from the home’s approach to risk taking, which assists them to be independent within their capabilities. The service users’ right to make decisions is respected, subject to some agreed restrictions being in place for safety reasons. EVIDENCE: Each of the three service users’ personal files looked at contained a care and support plan that had been written or revised during the last four months. The plans consisted of a range of forms, covering areas, such as ‘Safety Awareness’, ‘Social Skills’, ‘Communication’, ‘Medication’ and ‘Daily Routines’. They provided clear guidance for staff about the service users’ needs and preferences in these areas. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 11 The care plans had been signed by certain parties but did not show who had contributed to the care planning process or include a contents sheet. The written format of the plans meant that they were not accessible to all service users or meeting their individual needs. The manager reported that the accessibility of information for service users is being looked at as part of a communications project being undertaken by Cornerstones (UK). One part of the care plans included a section on ‘Issues’. Goals and personal objectives were also recorded, which showed how a particular issue was being followed up. The objectives covered a range of areas, with the aim of improving aspects of the service users’ lives. For example, the needs of an older service user were reflected in the issue: ‘Maintaining independence as growing older’. In this example there were several objectives recorded, including ones relating to how the service user could keep active, physically and socially, and maintain good health. Other ‘issues’ concerned the safety of service users when following a particular interest or choice of activity. One service user liked to collect second hand electrical items and objectives had been identified to ensure that this could be done safely. One of the objectives confirmed the need for the equipment to be PAT tested, with the service user ‘shadowing ‘ the tester. This looked like a very positive way of involving the service user and increasing their understanding of the issue. It was evident from the wording of the objectives that they have been discussed in detail with the service users, who had agreed the steps that need to be taken to achieve a goal. However, the goal forms did not include a section where progress could be recorded. The service users’ files included other guidelines and risk assessment records that provided more detailed information in areas such as safety in the community and behaviour. There were very clear references within the service users’ individual plans to show where risk assessments had been undertaken. The home was arranging review meetings for service users, in conjunction with family members and outside professionals. A meeting took place during the visit on 19 October for one service user, which was attended by the two of their relatives. The manager said that she had contacted the service user’s funding authority about a suitable date for the meeting but had been told that nobody would be available to attend. A representative from the resource centre attended by the service user was due to attend, but was unable to be present at short notice. House meetings were being held, when service users could comment on aspects of the home and be kept informed of developments. In the minutes of the last meeting on 8 October 2006, it was reported that that service users had talked about the inspector’s visit and about changes in the day care Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 12 arrangements. Staff had told service users about plans to refurbish the kitchen and to install a new shower. Service users made decisions about what meals they would like. The choice of meals was recorded in a kitchen file. Some restrictions on what service users could do were recorded in their care plans, together with the reason why these were necessary. This included, for example, a restriction on who a service user could travel with in a car. This had been agreed following a previous incident and the carrying out of a risk assessment. Following a risk assessment, there was also a restriction in place about the use of the kitchen. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. The service users have individual lifestyles and benefit from their involvement in regular activities outside the home. The service users’ rights and relationships are respected. Service users may benefit from, and their relatives appreciate, some further support with ‘keeping in touch’. There is a varied menu and service users enjoy their meals. EVIDENCE: Service users had regular occupation during the day, which involved participating in different activities outside the home. At the time of the inspection some service users were attending local resource and activities centres. Another service user said that they enjoyed their work at a community farm. Cornerstones (UK) were also providing their own day care activities which were available to service users. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 14 Most service users had some unstructured time during the week when they could make decisions with staff about what to do. During the visit on 5 October, one service user went out shopping with a staff member and other service users were occupied in the home. Two service users said that they went into the town centre regularly and liked to do things together. Service users talked about their interests and pastimes. Some service users had collected items, which they displayed in their rooms. One service user looked after two pet budgies in their room. In their survey, one service user commented that they like the arts and crafts and jewellery making that they do on one day a week. Other service users stated that they like going to a local activity centre during the week and can go shopping and to the pub at the weekends. Some service users were receiving encouragement and support with new activities, as part of their personal goals. Objectives were recorded in their care plans, such as researching local drama productions for a service user who was interested in the theatre. Skittles was being looked into as an activity that two service users could do in the winter months. One service user was hoping to start work in a local shop. One of the service user’s care managers commented very positively about the range of activities and occupations that were on offer to their client in the home. Information was recorded in the service users’ care plans about their family relationships and how they maintained contact. In their comment cards, two relatives stated that they are welcome in the home at any time, can visit in private and are kept informed of important matters affecting their relative in the home. One of these relatives mentioned that they are not phoned by the home, but the home responds well when receiving a phone call. Another relative stated that they did not visit the home and had experienced some messages not being passed on. This relative also mentioned that when something is sent to the home, nobody lets them know that the service user has received it. One relative commented that they did not always feel up to date about who was in the staff team and in the role of key worker. Relatives usually spend time in the home when visiting service users. There was discussion with the manager about the possibility of staff support being available when service users go out with their relatives. The manager said that this would be followed up. The rights and responsibilities of service users were commented on in their individual care plans. It was recorded that staff had talked to service users about the process of advocacy and given out a leaflet about this. The service users views on Church attendance were recorded, as were their wishes, when known, about funeral arrangements. The records generally showed that Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 15 service users were being well consulted about their views and time was being taken to keep them informed of events. It was recorded in the house meeting minutes that fire procedures had been discussed and the service users had talked about the inspection process and possible changes in the provision of day care. There were procedures and recording systems in place for staff to follow when supporting service users with managing their personal money. The financial records were being checked as part of a monthly evaluation process. The service users’ care plans included a section on voting. In the plans seen it was stated that service users would not understand the process and the impression was given that this was something that they would not participate in. This was later discussed with the manager. A section on ‘Eating’ in the service users’ plans, provided information about individual needs and preferences. The service users spoken with said that they liked the meals. A weekly menu was written in advance and service users helped to choose the meals. A staff member explained how pictures were used to assist one service user who did not have verbal communication. There was a record kept of the meals prepared each day, with details of any changes that had been made to the planned menu. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 16 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, 19 and 20 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. Service users benefit from the guidance that has been produced for staff, which helps ensure that personal care is provided in a way that service users prefer and meets their needs. Service users receive the support that they need with their health care. They are protected by the home’s arrangements for dealing with medicines. EVIDENCE: Day to day needs were described in the service users’ care plans, which also included guidance for staff about their usual routines at different times of day. There was evidence of the involvement of outside professionals and the Community Team for People with Learning Disabilities (C.T.P.L.D.). One service user had an epilepsy profile and intervention plan, which a Community Nurse had completed since the last inspection. The Community Nurse was one of several outside professionals who had agreed a protocol concerning the use of a listening monitor in the service user’s room. A risk assessment had also been undertaken, as it was recognised that the use of the monitor could have an impact on the service user’s privacy. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 17 A male member of staff met with was aware of gender issues concerning the provision of personal care to service users and described some guidelines about how personal care is given. Records relating to the service users’ health were recorded in individual files for each person. The information was clearly recorded under sections which included GP, Dental, Chiropody and Hospital. The records showed that service users had had recent contact with their GPs, dentists and other healthcare professionals. In their comment cards, the relatives confirmed that they are satisfied with the overall care provided. Comments were made that ‘the home does well in the care of the clients’ and that the care is ‘second to none’. Support for one service user with their health needs was reflected in one of their personal goals, which was to maintain independence by continuing to attend day care outside the home. In order to achieve this, several health related objectives had been identified, including the involvement of a behavioural nurse and support to attend a specialist neurological centre. It was recorded in the minutes of a staff meeting in October 2006 that key workers were to discuss flu jabs with service users. Service users received support with the administration and safekeeping of their medication. There was a written policy and procedure for this. Medication was kept securely and the administration records were up to date. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. Service users have the opportunity to raise concerns and are listened to by staff. Staff members receive training and guidance, which helps to protect service users from abuse. EVIDENCE: The manager reported that the home had not received any complaints during the last year. The Commission has also not received complaints about the home during this period. A pictorial complaints procedure had been produced for service users. It was reported in the minutes of recent house meetings that the procedure had been discussed with service users and they had been asked if they had any concerns. Some service users would require support with making a complaint. In their comment cards, two relatives stated that they were not aware of the home’s complaints procedure. The home has had experience of an adult protection investigation and what this involves. A staff member said that she had been given her own copy of the ‘No Secrets in Swindon and Wilshire’ booklet and that a Police Officer had visited from the Vulnerable Adults Unit to talk to staff. Prevention of abuse and the protection of vulnerable adults were included in the Cornerstones (UK) staff training programme. Records in the home showed Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 19 that the staff members who were met with during the visits had received this training in May 2006. The manager reported that the home’s policy on Adult protection was under review and due to be completed by the end of November 2006. There was a policy on physical intervention with service users. A staff member described the use of restraint as being a last resort if a service user is at risk of harm. The manager reported on three incidents when restraint has been used in the last 12 months. In their comments, both care managers said that that they have been given information relating to incidents and concerns during the last year and been contacted for advice. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is generally adequate and poor in one particular aspect. This judgement has been made from evidence gathered before and during the visits to the home. Some parts of the home have improved since the last inspection. The surroundings are homely, although some aspects of the accommodation would benefit from further attention. The home is generally clean and tidy, however the service users’ safety is compromised by the way in which storage has been arranged. EVIDENCE: The home is in a residential area and within walking distance of Devizes town centre. 9 Roseland Avenue was registered as a care home before 2002 and provides accommodation that was approved prior to the introduction of National Minimum Standards. Service users had their own rooms, which varied in size and outlook. Space for socialising in one of the bedrooms seen was very limited, although it was well personalised, as was the other bedroom that was looked at. Toilet and washing facilities were shared, rather than provided ‘en-suite’. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 21 Some decorating and refurbishment work had taken place during the last year. This included the fitting of a new floor covering in the area of the utility room, which was a requirement from the previous inspection. Current items in need of attention included an outside door that did not shut easily and the repair of an area of guttering and fascia board that had not been completed. The manager said that refurbishment of the kitchen has been planned. Some areas of the home were subject to a three-monthly ‘in-house’ inspection, the outcome of which was recorded. This inspection was limited in scope and primarily focussed on the condition of bedrooms, including their cleanliness and whether there were any obstructions. The inspection did not look at the condition of the external environment or refer to ways in which the accommodation and facilities could be improved or upgraded. For example, bedroom doors had been fitted with internal bolts as a means of service users securing their rooms, rather than having an appropriate type of lock, which would enable service users to safely lock their rooms from both sides of the door. There were also bolts fitted on the inside of the staff sleeping-in room door, which the manager confirmed were not used and would be removed. The home generally looked clean and tidy. Some areas of the home do not receive a lot of natural light and it would be worthwhile to look at ways in which this can be compensated for, for example by the use of different light fittings and brighter décor. During the visit on 5 October a bottle of bleach was being stored in an unlocked bathroom cabinet, which was at head height. Staff explained that there was a problem with the working of the lock, however the bleach had not been moved to a more secure and safer facility. The bottle was later removed and it was confirmed during the visit on 19 October that bleach was no longer being kept in the bathroom. There was a file in the office that contained C.O.S.H.H. data sheets. It was agreed with the manager that guidance would also be produced for staff, concerning the practical arrangements for the safe storage of any hazardous materials that are used in the home. The condition of the home’s detached garage was reported on at the last inspection. The garage door has since received attention. There was a requirement for the garage to be cleared and tidied into a more orderly fashion if it is to be used as storage area. The manager said that time had been spent on clearing the garage, although this did not last as further items had since been brought from outside the home for storage. These items were unrelated to the home and appeared to have been stored in a haphazard way. There was no clear demarcation between the storage area and the part of the garage where a freezer and a tumble dryer were in daily use. This use of the garage for storage was not only having an impact on a domestic area, but meant that it could not be developed as a new facility for service users, e.g. as a recreational area. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 22 An environmental health officer visited the home in June 2006. A new kitchen log book for the recording of food served and temperature checks has been introduced as a result of the visit. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. Service users benefit from staff members who are developing their skills and who receive regular training. Staff members know the service users well and service users receive good continuity of support. EVIDENCE: In addition to the manager and deputy manager there was a staff team of five support workers. One support worker had a National Vocational Qualification (NVQ) in care. The home had not yet achieved 50 of the staff team with NVQ, although the manager reported that progress was being made towards this. One member of staff was undertaking NVQ at level 3 and another person was undertaking NVQ at level 4. Two members of staff were due to start NVQ at level 2 at the end of October 2006. No staff members had left the home since the previous inspection. The staff members met with had worked in the home for a number of years and were very familiar with the service users’ needs and lifestyles. Learning Disability Award Framework (LDAF) training was available to new staff, however no new Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 24 staff had been appointed during the last year. Staff recruitment was therefore not looked at on this occasion; Standard 34 was met when it was last inspected in 2005. LDAF training has also been completed by some of the current staff during the last year, as this was not available to them when they were first employed. Staff meetings were being regularly held, with minutes kept. A training manager from Cornerstones (UK) co-ordinated staff attendance on a range of courses and training events. The home received a monthly training schedule / record, which included details of training events arranged for the coming months. Training booked for November 2006 included two staff attending food hygiene courses and one person attending a first aid course. There was a policy and training plan which set out the training that staff will receive, under the headings of ‘Essential’, ‘Desirable’, ‘Specialist’ and ‘Mandatory’. Priorities were identified for the training events that a staff member needs to attend during their first year. The training plan looked very comprehensive. Staff members had individual training records and the records generally were well presented. During the last year staff members had received training in areas including medication, abuse, infection control, manual handling, fire safety, epilepsy and first aid. The manager provided information about training that is due to take place in the coming year. This covered a range of topics and methods of training. In addition to learning disability related subjects, staff members also have the opportunity to attend a ‘How to Learn’ course. It was recommended at the last inspection that staff should attend continence promotion training. The manager said that there had been some difficulty in arranging this, although it had now been booked for early 2007. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 25 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): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. Service users benefit from a home manager who is experienced and is gaining relevant qualifications. Quality assurance is being well developed at an organisational level and further developments will be beneficial. Overall there are suitable arrangements in place for maintaining the health & safety of service users, although there are areas that would benefit from further attention. EVIDENCE: Lisa Harridine has been the home’s manager for over 3 years and was managing another care home in the Cornerstones (UK) group before starting at 9 Roseland Avenue. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 26 Lisa Harridine said that she was near to completing NVQ at level 4 in care and was also undertaking the Registered Managers Award. One care manager commented on the improvements that had been made in the running of the home since the current manager came into post. One of the service user’s relatives also mentioned this and felt that the home was going through a settled period. Quality assurance has been developed during the last year. A Cornerstones (UK) plan for quality assurance was produced in September 2006. This is a comprehensive document, setting out the organisation’s intentions and how these will be put into practice. The system included an internal audit of the standards and the sending out of questionnaires to outside professionals and to the service users’ relatives. Action plans are produced throughout the year. The quality assurance plan included a section on communication with service users and how the organisation will seek to establish effective methods to achieve this. This was discussed with the manager and with a consultant who is employed by Cornerstones (UK) and was met with during the visits. Feedback is being obtained from the service users and their representatives in various ways and it was confirmed that their views should be paramount within the organisation’s system of quality assurance, with their views reflected in the report that is produced under Regulation 24 of the Care Homes Regulations 2001. This regulation has recently been amended and includes details of the type of report that needs to be produced in connection with quality assurance. The manager said that the home’s Statement of Purpose was currently under review. This will need to reflect the current age range of the service users and one of the home’s conditions of registration is to be changed accordingly. There was also discussion about the need to review the Service User’s guide and to include details of fees and charges. This follows a recent change in the regulation concerning the contents of service users’ guides. Information was received from the manager about the arrangements in place for maintaining the home’s fire precaution systems and other servicing involving outside contractors. A fire drill and staff training in fire precautions had taken place in August 2006. Electrical checks had taken place in March 2006 and gas installations were serviced in July 2006. Risk assessments have been undertaken concerning the service users and staff members’ safety within the home. There was a no-smoking policy although a risk assessment had been undertaken in respect of a service user who smoked outside the home. Radiators in the home were covered and the water temperatures regulated. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 27 Some shortcomings were identified under the ‘Environment’ section of this report, which could have an impact on the service users’ health and safety. The most obvious of these, involving the storage of bleach was corrected at the time. Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 28 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 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA24 Regulation 23 (2) (b) Requirement The garage must be cleared and tidied into a more orderly fashion if it is to be used as storage area. This includes clearing any items that must be removed or destroyed, such as old paint cans. This requirement is outstanding from the previous inspection. In order to meet this requirement there must be a clear, physical division between the area of the garage that is used for storage and the area that is used for other, domestic purposes. Timescale for action 15/12/06 Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 30 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. Refer to Standard YA6 YA6 Good Practice Recommendations That the care plans are produced in formats that meet the needs of individual service users. That the service users’ progress with meeting their personal goals and objectives is consistently recorded, in order to show whether progress is being made as expected, or whether, for example a service user needs further support to achieve the goal. That the way in which service users keep in contact with their relatives is reviewed in order to ensure that good communication and exchange of information is maintained. That the service users’ capacity to vote is considered further and support provided to enable service users to exercise this right. That the service users’ representatives are provided with a copy of the home’s complaints procedure. That service users are offered the opportunity to have a key operated lock fitted to their bedroom doors. Where locks are fitted, these should be of a type that enables the door to be unlocked from either side in the event of an emergency. That further consideration is given to ways in the which the accommodation can be enhanced. That the scope of the three monthly inspection is extended to include the grounds and exterior of the home and looks in more detail at the standard of facilities and how this can be improved. That guidance is produced for staff concerning the practical arrangements that are in place for the safe storage of any hazardous substances that are kept in the home. That the use of the garage is changed in order to provide an additional space that can be used for the benefit of service users. 3. 4. 5. 6. YA15 YA16 YA22 YA24 7. 8. YA24 YA24 9. 10. YA24 YA24 Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. Extracts may not be used or reproduced without the express permission of CSCI Roseland Avenue (9) DS0000060339.V314214.R01.S.doc Version 5.2 Page 32 - 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. 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