Inspection on 30/04/05 for Avenue Lodge

This inspection was carried out on 30th April 2005.

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

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

Other inspections for this house

Avenue Lodge 04/09/06

Avenue Lodge 25/10/05

Avenue Lodge 21/10/04

Avenue Lodge 02/06/04

Avenue Lodge 29/01/04

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

CARE HOME ADULTS 18-65 Avenue Lodge 53 Avenue Road London SW16 4HJ Lead Inspector Liz OReilly Unannounced 30 April 2005 10:00 am th 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 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 Stationary 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. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Avenue Lodge Address 53 Avenue Road London SW16 4HJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 764 6125 Mr Nizam Hosane Mrs Anna Maria Oozeerally CRH Care Home 6 Category(ies) of MD Mental Disorder (6) registration, with number MD (E) Mental Disorder over 65 (6) of places Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st October 2004 Brief Description of the Service: Avenue Lodge is a care home for up to six adults with mental health needs. The home is owned by Mr N. Hosanee. The property consists of two terraced properties which have been joined together and extended. The home is situated in a residential area of Mitcham, close to local shops and public transport links. Unrestricted parking is available in the street. The property is not identifiable as a care home. The aims and objectives of the home are set out in the Service Users Guide with is provided to each resident. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on Saturday 30th April 2005 by one regulation inspector. The inspector had the opportunity to speak with four residents, one member of staff and the Registered Manager. At the last inspection of this home two requirements were made. These requirements have been complied with. What the service does well: What has improved since the last inspection? Since the last inspection of the home the Registered Manager has implemented in house training on mental health issues which provides care staff with a greater knowledge which will assist in understanding some of the problems residents face on a day to day basis. Staff have also been provided with training on medication which helps in safeguarding the health and safety of residents. The Registered Manager has completed NVQ level 4 training. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 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. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 5. Residents are provided with good information on the service they can expect from the home prior to moving in. Detailed assessments are carried out prior to a new resident moving into the home. Prospective residents are fully involved in the assessments offering them an opportunity to make choices about their lives. This also ensures that staff have good information on the individual needs, wishes and aspirations of each resident on which to base the care they provide. The needs and aspirations of individual residents were seen to be met. EVIDENCE: Before any decision is made regarding moving into the home staff meet with prospective residents, attend joint meetings, receive assessments from other professionals and carry out their own assessment of the needs and wishes of the individual. Assessments cover a wide range of issues including independence, choices, rights, mental health and social care. The assessment process provides residents with good opportunities to express their wishes and for staff to assess any risks for individuals. The various assessments and discussions with the resident are used to create an individual, agreed care plan. The needs and preferences of residents from minority ethnic communities were seen to be recorded and met. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 9 Since the last inspection of the home the Registered Manager has provided staff with information on various aspects of mental health care as part of their one to one supervision. This provides staff with a greater understanding of the needs of the individual residents so that they are better able to provide an individualised professional service. The contract for each resident was seen to provide them with information on their bedroom, the fees, the personal support and facilities they can expect from the home along with their responsibilities. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 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 standard(s) 6, 7, and 9 The care plans are of a very good standard setting out the strengths, needs and wishes of individual residents. Staff work to promote and or maintain independence and extend the choices available to individuals at a pace suitable and comfortable to the individual resident. Residents are supported to participate in the life of the home according to their own wishes. Risk taking is acknowledged by staff as part of developing an independent life and appropriate individual assessments are carried out to support this. EVIDENCE: Individual care plans are well maintained and reviewed in consultation with each resident. Plans were seen to include an agreed plan for new residents to be supported during their first few weeks. This involved staff working with the individual on a one to one basis to offer support and information on exploring the local area, daily routines and checking out the wishes and aspirations of the new resident. Residents are supported to complete an independence plan, a choices assessment, a rights plan, and a privacy plan. Residents are asked to share their likes and dislikes. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 11 The main care plan sets out the strengths, needs and wishes of residents in relation to socialising, leisure interests, mental health, medication, family and relationships, choices, independence, privacy and rights. Care plans were seen to be signed by the resident and staff. Discussion with staff and residents and observations made at the time of inspection indicated that residents are encouraged to make their own decisions on day to day activity. Individual risk assessments are carried out in relation to assistance required, self harm, absconding, drug or alcohol use, falls and harm to others. The risk assessments are carried out on admission to the home, review after six weeks and again every six to twelve months. The care planning could be further enhanced by requesting residents share a life history with staff. This may assist staff to understand individual residents previous life experiences which may allow for staff to gain a better understanding of behaviour and how to support individuals. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 and 17 Staff are committed to supporting residents to take up opportunities for engaging in leisure activities, further education and utilising community facilities according to individual needs and wishes. The Registered Manager strives to strike a balance between supporting people to make their own decisions on day to day living and offering opportunities to expand residents experiences. Family and personal relationships are encouraged. The rights of individual residents form part of individual care planning documentation. Comments from residents indicated they were very happy with the quality and quantity of food provided. EVIDENCE: Residents attend day centres and work based centres according to their own wishes and needs. Staff provide residents with information on local services and activities. All residents are able to use public transport. Should residents decide on a group trip then a mini bus is used. Each resident is registered to vote. Staff time is made available to support service users in activities outside the home according to individual need. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 13 Residents stated they were free to meet with visitors at any time and could use the communal areas of the home or their own room to meet with friends or relatives. Residents are free to develop their own personal relationships. Within the home residents are involved in assisting with domestic tasks according to their own wishes. Residents stated they “helped out” with washing up and cleaning and if they thought someone in the group was not helping enough they would bring this up at a meeting. Residents have free access to all communal areas of the home. Residents stated they were aware of the rules on smoking and alcohol in the home. The inspector had an opportunity to share a meal with residents. Residents stated they enjoyed the food. Menus are discussed at residents meetings. A number of residents get their own breakfast at their own pace. The lunch and supper are prepared by staff. The kitchen is open at all times and residents stated they felt they got plenty to eat and the food was “very good”. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, and 20. None of the residents in the home at the time of this visit required assistance with personal care. The physical and emotional health needs of residents is monitored and staff have good relationships with community health teams. Medication is well managed within the home. EVIDENCE: Residents are all registered with local GP’s. Staff provide advice and support for residents in relation to personal care. Each resident is allocated a keyworker from the staff group. Residents can change their keyworker should they feel they are not getting on. Arrangements are in place for residents to receive dental and optical care in the community. The home has good links with the community psychiatric team. A letter from the visiting psychiatrist expressing satisfaction with the care provided in the home was seen on this visit. Residents receive visits from healthcare professionals in private with staff available to offer support should they request this. At the time of this visit none of the residents were self medicating. Medication was seen to be well managed with good records in place. All staff who administer medication have received accredited training on the management of medication. One resident stated “we get our right medication at the right time”. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 15 Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 16 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 standard(s) 22 and 23. The home has a clear complaints procedure. Residents stated that they knew that if they had a concern or problem they could talk to the staff, manager, their community psychiatric nurse or their social worker and it would be dealt with. Residents are protected from abuse. EVIDENCE: A complaints procedure is in place and is on display in the home. The work carried out by staff when a new resident moves into the home was seen to include going through what they should do if they have a complaint. The home keeps a record of any complaints with details of any actions taken. Residents spoken to at this visit expressed confidence in the staff to sort out any problems they may have but also knew they had the right to take a complaint to other people outside the home. The home has a clear procedure for dealing with any allegation or concern they may have regarding abuse. A copy of the local authority procedure is available in the home. Staff are aware of their responsibility to report any concerns they may have. The Registered Manager is aware of her responsibilities to report any concerns regarding staff to the appropriate authorities. The Registered Manager discusses the reporting process and the types of behaviour which may be abusive during one to one supervision and during staff meetings. At the time of this visit staff were also on the waiting list for a training course to be held by the local authority. The various assessments in place in relation to independence, privacy and choices indicate that the rights of service users are of a high priority in this home. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 17 Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 18 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 standard(s) 24, 27 and 30 The home provides a comfortable, homely environment for residents. The privacy of residents is protected when using bathrooms and toilets. The home is clean, tidy and hygienic. EVIDENCE: The home was found to be comfortably furnished in a domestic style. The majority of the furnishings seen were of a good quality. However it was noted that some items of furniture were showing signs of wear and tear. The home owner should carry out a review of the furnishings in the home in order to set up a rolling programme of replacement. A well maintained garden with a patio area and an aviary is available to the rear of the home. The Registered Manager informed the inspector that the requirements for the replacement of the sealant round the bath and the replacement of the flooring in the first floor bathroom had been completed. The home was found to be clean and tidy. One resident stated “the sheets and blankets are changed regularly” and the described the home as “nice and airy”. A separate laundry area is provided for residents use. Staff offer support and assistance to residents in carrying out their laundry this offers residents further opportunities to develop their independence. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 19 Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35 Residents are supported by a flexible committed staff team. EVIDENCE: The numbers of staff on duty in the home vary according to the needs and activities of the residents. A minimum of one member of staff is available in the home at any one time. At the time of this visit two staff, including the Registered Manager were on duty. At night one member of staff sleeps on the premises with another member of staff on call within the local area. A record of any instances where the person on call has been required to attend the home is kept to ensure that this arrangements remains appropriate to the needs of the residents. There is low staff turnover and sickness which provides residents with stability and consistency. Regular staff meetings take place which ensure that all staff are kept informed of any issues, any changes in individual needs can be discussed and the aims and objectives of the home can be reinforced. The staff meetings assist in ensuring constancy in the approach and care provided for individual residents. Residents are invited to attend staff meetings. Since the last inspection of the home the Registered Manager who is a qualified nurse has focused in house training on mental health issues. Records showed discussions on anxiety, managing Schizophrenia, perceptions and interventions as part of one to one supervision. This information and training will assist care Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 21 staff to gain a greater understanding of the strengths and needs of the resident group. In order to ensure that the training needs of staff are met each member of staff is supplied with an individual training and development profile. This shows that all care staff have received at least five days paid training each year to ensure that residents are supported by a well informed staff group. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39 and 42 The home is well managed with opportunities for residents to voice their opinions on how they would like the home to be run. Progress is being made to develop self monitoring to ensure that the home is working within its stated aims and objectives and meeting the needs of the residents. Further work should be carried out in this area to pull together information into an annual report. Staff take their responsibilities to ensure the health and safety of residents seriously. EVIDENCE: This is a small home where all residents see the Registered Manager on a day to day basis. In addition residents views on the home are sought via residents meetings and keyworker meetings. Residents have opportunities to discuss their individual needs and wishes within the care planning and review meetings. Discussions with the Registered Manager indicated that she has a clear understanding of the strengths and needs of all the residents and staff within Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 23 the home. She expressed a commitment to ensuring that residents are provided with a “home” where routines are dictated by the wishes of residents. At the time of this visit one resident said that things could be improved by more biscuits being provided in the afternoon. The Registered Manager immediately arranged for more biscuits to be provided. In order to assess if they are meeting the needs of residents a questionnaire has been compiled for residents to give their opinions. The opinions of other professionals, family and visitors to the home have been sought to assess whether the home is meeting its stated aims and objectives. The Registered Manager and the owner should ensure that the results of an annual assessment of the service are set out in a report. A copy of this report should be provided to the Commission. The owner must ensure that once every month, after a visit, he compiles a report on the home with a copy of each report sent to the Commission. To ensure the health and safety of the residents in the home regular checks are carried out on the fire alarm system, the temperature of hot water, the fridge and freezer temperatures, and electrical items in the home. Staff have taken part in food hygiene training. A record of any accident or incident occurring in the home is kept along with any actions taken by staff. Once a month a health and safety check is carried out on the whole home. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 24 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 3 x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Avenue Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 2 3 x x 3 x G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 38 Regulation 26 Requirement The Registered Provider must ensure that copies of the report produced following a monthly visit are supplied to the Commission. Timescale for action 10th June 2005 2. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 6 24 39 Good Practice Recommendations Consideration should be given to requesting residents supply a life history for their file to include any information on their past they are willing to share with the staff. The Registered Persons should carry out a regular review of the furnishings in the home in order to set up a rolling programme for renewal. The Registered Persons should ensure that a report is produced following an annual review of the service. A copy of this report should be provided to the Commission. Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 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 Avenue Lodge G54-G04 S27251 Avenue Lodge V225393 300405 Stage 4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!