Inspection on 28/12/07 for Avalon House

This inspection was carried out on 28th December 2007.

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

The inspector found 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Avalon House 24/11/08

Avalon House 05/04/07

Avalon House 27/02/06

Avalon House 17/08/05

Avalon House 09/11/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Avalon House 114-116 Manor Avenue Brockley London SE4 1TE Lead Inspector Ornella Cavuoto Unannounced Inspection 28 December 2007 & 7 January 2008 10:00 th th DS0000025605.V348728.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 DS0000025605.V348728.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. DS0000025605.V348728.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avalon House Address 114-116 Manor Avenue Brockley London SE4 1TE 0208 6942717 0208 691 5107 ruth@auroraoptions.org.uk 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) Aurora Options Care Home 12 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places DS0000025605.V348728.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 12 persons with a learning disability, one of whom may be a wheelchair user 5th April 2007 Date of last inspection Brief Description of the Service: Avalon House provides a care home to a maximum of twelve women and men with severe learning disabilities, who might also have other support needs. The overall aim is to provide a service driven by the needs, abilities and aspirations of the service users and placing their rights at the forefront. The home declares its core values to be: individual approaches, equal opportunities, inclusion and shared values. Avalon House aims to achieve this by ensuring that the service would be based on a thorough assessment of needs and delivered in collaboration with external agencies. Staff would seek to advance the rights to privacy, dignity, independence, security, civil rights, choice and fulfilment in all aspects of their work and of the environment. The provider, an organisation originally named The Aurora Charity has recently changed its name to ‘Aurora Options’. It also runs other homes. A chief executive and a service manager, to whom all the staff are ultimately accountable, direct the service. The day-to-day running of the home is delegated to a care manager, who leads a team of staff. Accommodation is provided in two converted, adjacent, Victorian houses and is set on four floors. There is a small garden and a multi sensory room. There are 12 single bedrooms. None have en-suite facilities. Provision has been made for one of the bedrooms to accommodate a person using a wheelchair. There is a minibus to facilitate group outings. The area is served by public transport and has a selection of shops and a supermarket. At the time the inspection was held there were two vacancies. In respect to making information about the service available to potential service users the home has a brochure, which it sends out to referrers. The service user guide is presently under review. CSCI inspection reports are made available by directing individuals to the CSCI web site or a copy will be sent to individuals on request. The home has a block contract with Lewisham Social Services. However, monthly fees for the home average at £836.50. This information was provided to CSCI May 2007. DS0000025605.V348728.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over the course of two days. The manager had only been in post for three weeks at the time the inspection was held and the deputy manager who was also present for the inspection on both days had been in post for 2 months. Both were involved in the inspection process. Also, one staff member who had recently started working at the home and one service user were spoken to as part of the inspection. The development manager was spoken to shortly after the inspection to gain clarification on specific issues. A partial tour of the premises was undertaken and records were looked at. An Annual Quality Assurance Assessment (AQAA) was sent out prior to the inspection and completed and returned to CSCI. This will be referred to within the report. What the service does well: What has improved since the last inspection? The home has purchased a new chair lift for the home to ensure all parts of the home can be safely accessed by one of the service users who has mobility issues. Written notifications of any serious incidents that involve those living at the home as required by regulation have been provided to CSCI. DS0000025605.V348728.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. DS0000025605.V348728.R01.S.doc Version 5.2 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 DS0000025605.V348728.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was committed to a full assessment of individuals’ needs and aspirations before offering a place to live at the home. EVIDENCE: Since the last inspection one service user had been transferred to live at Avalon House from one of the other homes run by Aurora Options. There was evidence within daily records that the service user had visited the home with their parents and the allocated social worker prior to moving in to ensure they were happy with the transfer. In respect to new admissions to the home the policy of the organisation is that service users who may want to move in would need to receive a full assessment by the appropriate professionals. Only then would the home confirm the offer of a place, if identified needs and aspirations could be met. DS0000025605.V348728.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7&9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was an individual plan in place for service users that covered all areas of need but not all of them had been updated to reflect changing needs. Service users had been supported to make decisions about their lives. Risk assessments to support service users to live independently were in place but not all had been reviewed. EVIDENCE: The personal files of three service users were looked at. All included a care plan that did cover aspects of personal and social support and healthcare needs but these had not all been reviewed at least six monthly as specified within National Minimum Standards (NMS) or updated to ensure that service users’ changing needs and progress were reflected, for example one service user whose behaviour had previously been found to be very challenging by staff had significantly improved but their care plan was last updated in January 2007. For another service user their care plan was dated July 2006. Both the manager and deputy manager acknowledged that this was an area that had DS0000025605.V348728.R01.S.doc Version 5.2 Page 10 been neglected. The home had experienced a high turnover of staff over the past year and a manager had not been in post since January 2007. There was evidence that some measures had begun to be taken to address this. For all three service users whose personal files were looked at review meetings in which family members and service users had been involved, had recently been held and personal goals for the next six months had been identified. These had been drawn up using pictures to make them more accessible to service users. It was reported that in total four reviews had been undertaken with service users and further reviews were arranged for January 2008. In addition, to the more formal care plans that were in place there was evidence of personal support plans that had been drawn up with service users. These were in a more accessible format with simple language being used and pictures to enable service users to understand the plans more easily. They contained a lot of information about service users’ needs, preferences and lifestyles. Furthermore, individual specialist requirements were addressed with guidelines and interventions in place for staff about how to meet the needs of service users. However, it was evident that the support plans and many of the guidelines in place also needed reviewing with a view to updating the information where required. The manager reported that some changes to individual plans were to be made so that they were more person centred. There was evidence of new forms within the plans that were to be completed with service users. Although the measures taken to address the shortfalls in this area were positive, the same issues with regards to care plans were identified at the last inspection held in April 2007. At that time some action, for example some reviews had been held with service users to address the problem that care plans had not been updated. As a result a requirement was not specified. Yet, due to the ongoing concerns about care plans identified at this inspection a requirement is to be specified in this report. Also, at the last inspection it was noted that annual reviews conducted by the placing authority had not been undertaken. At this inspection it was reported that placement reviews for two service users had been recently held and there was evidence that for another service user their social worker had been contacted to arrange a review. However, the home needs to ensure all service users have a review conducted by the placing authority (See Requirements). There was evidence from the reviews recently held with service users that they had been involved and were supported to make decisions about their own lives. Also, minutes that were seen from a house meeting that had been held with service users demonstrated they had been involved in making decisions about social activities they wanted to be involved in as well as other aspects of the running of the home. These meetings are aimed at being held six weekly. At the last inspection detailed risk assessments to support service users to lead independent and fulfilling lives as possible were in place but these had not been reviewed within the past year. At this inspection some action had been taken to address this with risk assessments for individual service users having DS0000025605.V348728.R01.S.doc Version 5.2 Page 11 been reviewed but for other service users this was still to be addressed (See Requirements). DS0000025605.V348728.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 &17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are able to enjoy a full and stimulating lifestyle and are supported to be involved in areas of daily living including planning meals and meal preparation. Their individual rights are generally promoted which includes maintaining and developing personal relationships. EVIDENCE: There was evidence available within individuals’ personal files and weekly activities schedules in place that demonstrated that the those living at the home had been involved in a range of activities that include doing various classes at the day centres they attend such as pottery, cookery, drama, sports amongst others as well as attending community education classes in subjects that include computers, looking at friends and relationships and literacy. They have also had opportunities to get involved in leisure activities and to socialise with others such as going bowling and attending the Gateway club. It was reported one of the people living at the home had become involved in a DS0000025605.V348728.R01.S.doc Version 5.2 Page 13 rambling club. The manager also stated that a future aim is to try to access more employment opportunities for service users. It was evident from the personal files belonging to those living at the home that they were very much part of the local community using the local shops, pubs, restaurants, cinemas and leisure centres as well as other local facilities. One service user spoken to confirmed they had regular contact with relatives and there was evidence from personal files that other service users had contact with family members and friends. There was evidence that the home is run to promote service users’ individual choice and independence in that service users are involved in doing household tasks with the support of their key workers such as their laundry and tidying their rooms and also in doing the food shopping for the home. However, it was noticed in undertaking a tour of the premises that service users did not have locks on their bedroom doors and so they would not be able to lock their rooms if they wished, compromising their right to privacy. This was swiftly addressed by the home with evidence seen on the second day the inspection was held that locks for all service user bedrooms had been purchased and were to be fitted. Service users are encouraged where appropriate to prepare their own breakfasts and lunch if they are around although generally they are out at lunchtimes attending day centres or doing other activities. In respect to evening meals, there is a cook who prepares the evening meal during the week. At the weekends staff do this. Service users had been involved in menu planning, which was confirmed by a service user spoken to. Cooking sessions involving residents are also held with key workers. Records showed that all those living at the home receive well-balanced nutritious and varied meals. Individuals can choose from a range of frozen meals if they do not like the meal that has been prepared. Snacks and drinks are available outside of meal times. DS0000025605.V348728.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home receive effective healthcare support but records indicated that there had been inconsistencies in personal support received by service users and staff had not always accurately adhered to medication policies and procedures to protect service users. EVIDENCE: People living at the home are encouraged where possible to take responsibility for their own personal care and staff prompt and provide support where required. This had been addressed within care plans. Service users were observed as being well dressed and groomed. The home operates a key worker system to ensure consistency of support and continuity although records within personal files indicated that key worker sessions had not been held for some months. In one file the last key worker session recorded was May 2007 whilst in another file looked at it was August 2007. The manager and deputy manger again acknowledged this was an area for improvement and a new form specifically to record key worker sessions was seen that had been developed. However, it is important as a means of supporting service users that the DS0000025605.V348728.R01.S.doc Version 5.2 Page 15 regularity of key worker sessions are maintained and that this evidenced by maintaining records (See Requirements) There was evidence within care plans and also for each service user there was an up to date record of appointments that had been attended with a range of different health care professionals including GPs, chiropodists, dentists, opticians, physiotherapists, neurologists and speech therapists amongst others. Staff had also written up a brief note on the outcome on each appointment attended. The home uses a blister pack system for storing and administering medication. None of the people presently living at the home take responsibility for their own medication. There was a list of signatories in place of those staff who were trained to administer medication. Training is accessed for staff via Lewisham Partnership, which provides three units of medication training. It was evident from staff files checked that the majority had completed one or more of the units of medication training. Also, since the last inspection a comprehensive competency assessment drawn up by Lewisham Primary Care Trust had been introduced by the home. The deputy manager reported that staff would not be able to administer medication until they had completed the competency assessment and at least the first unit of medication training. However, apart from the deputy manager it was identified only one of the recently employed staff had completed the competency assessment. It is advised all staff including those more established staff should do this to ensure good practice is being maintained. A sample of six medication records belonging to service users was checked. Four of the records included gaps where medication had been given but not signed for and one had not been signed on one occasion and the medication had not been administered. In addition, for one service user some of the items to be administered did not have clear instructions on the medication records or on the packaging of the items. Yet, staff had used a code indicating the medication had not been given but was to be administered ‘as and when required’. This needed to be clarified and clear instructions for all medications should be written on medication record sheets. Furthermore, it was noted that although fridge temperatures for medication requiring cold storage had been checked daily and recorded to ensure that they remained within recommended limits, the room temperature where the medication was stored had not been checked to ensure it did not exceed 25c. It is advised this is addressed. In respect to a previous recommendation that staff should be advised about the correct use of codes to be entered on medication record sheets for when medication is not administered, it was evident at this inspection that this had improved (See Requirements & Recommendations). DS0000025605.V348728.R01.S.doc Version 5.2 Page 16 DS0000025605.V348728.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had an accessible complaints policy and service users had been made aware of their right to complain. The home has taken measures to ensure service users are generally protected from abuse although the systems in place for managing service users’ finances need to be more robust. EVIDENCE: Since the last inspection the home had updated its complaints policy. This was written in simple language and used pictures. There was evidence from minutes of a service users’ meeting that had been held in which making a complaint had been discussed with service users; the reasons why they may need to make a complaint and who they could talk to about this. However, there was no information available in respect to how service users may access independent advocacy and it is advised this is addressed. The complaints log was not available for inspection but evidence of a complaint made by a service user that they had been shouted at by one of the bank workers, was sent to CSCI shortly following the inspection. This demonstrated that the complaint had been investigated and appropriate action had been taken. This had also been reported to the local authority. The complaint had been partially substantiated (See Recommendations). There was evidence that the majority of support workers had completed adult protection training provided by Lewisham Partnership. Adult protection is also addressed as part of the Learning Disability Foundation Award (LDAF), which was being completed by all newly recruited staff. Since the last inspection DS0000025605.V348728.R01.S.doc Version 5.2 Page 18 there had been two adult protection investigations undertaken in relation to the home. The first investigation undertaken by Lewisham Partnership following an anonymous allegation of inappropriate behaviour towards a service user was found to be unsubstantiated. The second investigation related to concerns raised during the inspection relating to three of the staff behaving inappropriately towards two of the service users constituting emotional abuse. Adult protection procedures were followed with the allegations being reported to the local authority. An investigation was carried out by the home and a detailed report of this was sent to the local authority and also to CSCI, which concluded that the allegations were not substantiated. In respect to service users’ finances none of the service users at present manage their own finances. It was reported that for individual service users the previous development manager that had left the home since the last inspection and the home’s finance manager presently had responsibility for their finances acting as power of attorney. However, the home was in the process of passing this responsibility to the new development manager and the deputy manager. A small sample of service users’ finances were checked and two of the records did not correctly balance; one was a small amount over and another slightly over. It was reported that regular audits had not been carried out. Individual records of transactions were maintained but these had been written on very small notebooks, which were difficult to read. It is advised that proper cashbooks or balance sheets are used. Also, it was noted that not all staff had signed the notebook when they had carried out a transaction and neither had they signed the petty cash receipts used. Receipts for purchases were in place (See Requirements and Recommendations). DS0000025605.V348728.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26, 27, 28 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical environment of the home is comfortable and generally well maintained but the home was not completely free from offensive odours. EVIDENCE: The home is homely, comfortable and generally well maintained and furnishings are domestic in character. At the last inspection, concerns were raised about the suitability of the home specifically for one resident whose support needs had increased and their room was on the second floor that meant they were required to manage a flight of stairs. Also, there were quite steep stairs down to the dining room situated on the ground floor. Although there was a chair lift this was not in working order and it was reported that this could not be repaired, as the chair was no longer in production. Also, despite the home having a ground floor room it was reported that the service user occupying that room would be reluctant to change rooms although they did not present with any specific needs that required them to be on the ground floor. At this inspection it was identified that a requirement for the home to replace DS0000025605.V348728.R01.S.doc Version 5.2 Page 20 the chair lift had been addressed. Furthermore, it was reported by the manager and deputy manager that following consultation with both service users with reviews held involving family members, that they had both agreed to change rooms. This was confirmed by one of the service users spoken to. A timescale for when this would occur was not specified although plans to initiate the swap were being undertaken including the ground floor room being assessed by an occupational therapist. Individuals’ bedrooms were inspected and all of them were personalised and reflected their personalities and cultural needs. Subject to a previous requirement that a carpet in one of the rooms should be cleaned, as it was quite stained and dirty, this had been addressed. In addition, as mentioned in respect to Standard 16 it was noted at this inspection that service users’ rooms did not have locks. However, the home took prompt action to address this by purchasing locks to be fitted on all service users’ doors. There were sufficient bathrooms and toilets to meet service users’ needs. However, it was noted that there was mould on the walls of both bathrooms on the second and third floors of the home. This needs attention (See Requirements). The home had communal spaces that generally were accessible, safe and spacious. There were two lounges on the first floor, one of which had a television and the other that was used for activities or where service users could sit quietly. On the ground floor there was a large dining area and kitchen. There was also an attractive garden, which was paved and had a seating area for people. The garden was accessible from the dining room and on the first floor there were also stairs leading down to the garden. On the day the inspection was held the home was clean and generally hygienic although one of the service users’ bedrooms did smell offensively of urine. The room belonged to one of the service users who was to be moved to a different room and it was reported that when this occurs suitable alternative flooring would be looked into as a measure to try to minimise the problem. However, the home needs to find ways in the interim period that this occurs to manage this more effectively and keep all areas of the home free from malodours (See Requirements). DS0000025605.V348728.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 &35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s recruitment practice is robust and all staff receive relevant training to ensure the needs of the people living within the home can be met. However, staff have not received regular supervision. EVIDENCE: The home has eight full time support workers and two bank workers presently working at the home as well as the new deputy manager. It was reported that three of the full time workers had achieved a National Vocational Qualification (NVQ) Level 2 and two of these were to start studying for the NVQ Level 3. Both bank workers had also completed a NVQ Level 2. The deputy manager had completed the Registered Managers Award (RMA) and also a degree. They reported they were intending to do the NVQ Level 4 in care. In addition, as mentioned in respect to Standard 23 all the new support workers including the deputy manager were in the process of completing the Learning Disability Award Framework (LDAF) units 1-4 (See Standard 35 for further details). This can be used towards the achievement of a NVQ. Due to the number of staff having achieved a NVQ or a higher qualification the home has met the required 50 target specified within the National Minimum Standards (NMS). DS0000025605.V348728.R01.S.doc Version 5.2 Page 22 Also, with other staff undertaking the LDAF it was evident the home was taking measures to ensure staff working at the home were of a competent standard to ensure service users’ needs could be met effectively. The rota was checked and it was evident from this and observation that there were sufficient levels of staff on duty. In addition to permanent staff the home uses bank workers and some agency staff who have worked at the home on a regular basis and so are familiar with the service users and the home. In relation to recruitment five staff files belonging to workers that had commenced working within the home since the last inspection were checked. These all included the necessary checks and information required by regulation including an Enhanced Criminal Record Bureau (ECRB) check, two references, appropriate identification documents. There was also evidence that any gaps in employment had been checked and for three of the workers evidence of the interview process was included in their files. An up to date photograph of all staff were in place. Copies of certificates of training completed by support workers were included in their staff files. There were also individual records that listed training courses that had been undertaken. It was evident from these that the majority of support workers had completed training in mandatory topics such as manual handling, fire safety, first aid and food hygiene. As mentioned in relation to Standard 32 all newly recruited support workers are required to complete the Learning Disability Foundation Award Units 1-4 within their probationary period which links in with NVQ training and Common Induction Standards. It was also reported they had a basic two -week induction. Although a staff member that was spoken to confirmed they had been inducted there was no evidence of this and what had been covered. A record of this should be kept within staff files. In relation to other specific training courses to ensure workers were able to meet the joint and individual needs of service users, there was evidence that a range of different courses had been completed and also booked for workers to attend, these included management of aggression, epilepsy, skills teaching, sexuality and learning disabilities amongst others. It was evident from records that staff had not received supervision regularly to ensure they had been provided with at least six sessions a year as specified with NMS neither had staff received an annual appraisal (See Requirements). DS0000025605.V348728.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 &42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been instability in relation to the management arrangements of the home although measures had been taken to address this. The home does have systems in place to ensure the views of service users are obtained but these had not all been fully implemented. The health, safety and welfare of service users are promoted and protected. EVIDENCE: The home had been without a registered manager in place since January 2007 and interim management cover had been provided by the development manager and other registered managers from other Aurora Options homes. It was evident through the completion of the inspection that some aspects of the day-to-day running of the home had been affected as a result of not having a manager with sole designated responsibility for the home. However, as mentioned in the summary of the report a new manager was in post at the DS0000025605.V348728.R01.S.doc Version 5.2 Page 24 time the inspection was held who had been in post for three weeks. It was evident in discussions with the manager that they had the appropriate skills, knowledge and experience to ensure the home was well run and that they had already begun to identify areas for improvement. An application for registration was to be submitted. In relation to quality assurance mechanisms used by the home there was evidence that surveys had been developed that were in an easy read format to obtain service users views as part of self-monitoring. It was reported these were to be issued to service users within the next three months although an annual survey had not been completed for 2007. At the last inspection it was reported that as part of the last survey conducted by the home in October/November 2006 the views of relatives and stakeholders had not been obtained. It is advised this is addressed by the home as part of the forthcoming survey. In addition, the Annual Quality Assurance Assessment (AQAA) sent to CSCI prior to the inspection had been completed to a satisfactory standard and monthly provider reports had been completed and regularly sent to CSCI (See Recommendations). The home had comprehensive health and safety policies in place. Up to date maintenance certificates were in place for gas safety, electrical wiring and there was evidence that portable electrical appliances had been tested. Fire equipment had been checked and maintained and fire alarm call points had been tested as required and fire drills had been undertaken. Water temperatures to prevent scalding had been recorded. At the last inspection, it was identified that the home had not taken action to report a significant incident as required under regulation 37 of the Care Standards Act 2002. However, appropriate reporting of incidents has been undertaken by the home since this time. DS0000025605.V348728.R01.S.doc Version 5.2 Page 25 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 3 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 3 X X 3 x DS0000025605.V348728.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 14 (2) Requirement The registered provider must ensure that annual placement reviews for all those living at the home take place with the placing authority to ensure the home can continue to meet their individual needs effectively. (Previous timescale of 31/12/07 partially met) The registered provider must ensure service users’ care plans and other relevant documents relating to the care and support of service users are reviewed at least six monthly and any changes or progress are clearly reflected. The registered provider must ensure that risk assessments drawn up for individuals living at the home are reviewed at least six monthly to ensure any changes in need are included. (Previous timescale of 31/08/07 not met) The registered provider must ensure that key worker sessions are provided on a consistent basis and records of sessions are maintained so that support DS0000025605.V348728.R01.S.doc Timescale for action 30/06/08 2. YA6 15(2) 30/06/08 3. YA9 15(2)(b) 30/06/08 4. YA18 12(1) 30/06/08 Version 5.2 Page 27 5. YA20 13(2) 6. YA20 13(2) 7. YA23 16(2)(l) 8. YA27 23(2) (b) 9. YA30 16(2)(k) 10. YA36 18(2) provided to service users can be monitored and ensure all their needs relating to their health and welfare are being addressed. The registered provider must ensure that all staff adhere correctly to medication policies and procedures, specifically that they sign medication records after they have administered medication and that service users receive all the medication prescribed to them. The registered provider must ensure that written instructions for all prescribed medications are specified on service users’ medication records. The registered provider must ensure that service users’ finances are regularly audited and that all staff sign when they carry out any transactions on behalf of service users to ensure service users’ are protected from financial abuse. The registered provider must ensure that the mould in the bathrooms is treated and removed The registered provider must ensure that all areas of the home are kept free from offensive odours. The registered provider must ensure that all staff receive at least six supervision sessions a year. 30/06/08 30/06/08 30/06/08 30/06/08 30/06/08 30/06/08 DS0000025605.V348728.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA20 YA20 YA22 YA23 YA39 Good Practice Recommendations The registered provider should try to ensure all staff undertake the medication competency assessment to ensure good practice is being maintained. The registered provider should try to ensure that the room temperature where medication is stored is monitored and recorded on a daily basis to ensure it does not exceed 25c The registered provider should try to obtain information about independent advocacy services to support service users in relation to making complaints. The registered provider should try to obtain cashbooks or proper balance sheets for staff to record financial transactions in relation to service users’ finances. The registered provider should try to obtain feedback from relatives and other stakeholders as part of self-monitoring when carrying out the annual survey. DS0000025605.V348728.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 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 © 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 DS0000025605.V348728.R01.S.doc Version 5.2 Page 30 - 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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