Inspection on 11/09/06 for Avenue The (3)

This inspection was carried out on 11th September 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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Avenue The (3) 25/06/07

Avenue The (3) 02/11/05

Avenue The (3) 29/06/05

Avenue The (3) 03/11/04

Avenue The (3) 12/05/04

Avenue The (3) 29/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Avenue The (3) Acocks Green Birmingham West Midlands B27 6NG Lead Inspector Monica Heaselgrave Announced Inspection 11th September 2006 09:00 Avenue The (3) DS0000016988.V306743.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 Avenue The (3) DS0000016988.V306743.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. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avenue The (3) Address Acocks Green Birmingham West Midlands B27 6NG 0121 693 0182 0121 693 0185 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) Kelso Care Consortium Limited Miss Sophie Kay Donnelly Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents must be aged under 65 years That Miss Donnelly completes her Registered Managers Award by April 2005. Date of last inspection Brief Description of the Service: The Avenue is registered to provide personal care and support to 10 adults who have a learning disability. Some people have additional needs in relation to behaviour that may challenge. Currently there are nine services users accommodated all of whom are male. The accommodation comprises of two communal lounges, dining room, kitchen and a laundry. There are ten single bedrooms with en-suite facilities. These provide a good degree of privacy for the people accommodated. There is also a separate bathroom available on the first floor. The second floor of the property houses a separate domiciliary care team, who are not part of the registered home, but prospective service users should be aware that people not concerned with their care will be entering the building. The Proprietor has developed a policy outlining how service users needs for privacy in their home, will be protected. There is no wheelchair access to the front of the building people need to be able to negotiate the steps to the door. Current service users do not require wheelchair access. There is a graduated path to the rear of the property and a portable ramp is available to assist people who would have difficulty in accessing the building. However this ramp may not be suitable for all types of wheelchairs. The rear garden is level enabling service users to make full use of it. There is a garden house with seating in it for those service users who wish to smoke. The home is in a residential road close to Acocks Green shopping centre. There is allocated parking to the rear of the property. The Avenue is ideally placed to access Birmingham city centre and a number of smaller shopping centres. Acocks Green offers a wide choice of local community facilities and places of worship. There are a number of local bus routes. The railway station is a fiveminute walk away. The current charge for living at the home is £1012.66. Additional charges include, outside activities, trips and outings (unless used from the holiday entitlement), chiropody, hairdresser, newspapers and additional meals out. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork of this unannounced inspection took place over one day lasting about 10 hours, enabling the morning, lunchtime and evening routine to be observed. Prior to the inspection Prior the inspector received a pre inspection questionnaire completed by the home. Information from visiting professionals concerning their experiences of the care and service provided is included in this report. Six service users were spoken with individually and the care delivered to service users was observed. A review of all information that the Commission has received since the previous inspection, was undertaken, considered and included in this report. Two service users were chosen to be case tracked so that a judgement could be arrived at as to how well their needs are known, and planned for. This included looking at their care file, daily records, and activity plans. Records relating to the recruitment, training, supervision, and work patterns of staff were examined. Medication records and stocks were sampled. Two staff were interviewed as well as the manager. A tour of the building was undertaken and six bedrooms were sampled to ensure they met with service users needs. Examination of the procedures in place to protect the health and safety of service users was undertaken. What the service does well: Staff were well informed as to the needs of service users, interacted well, and managed to anticipate the behaviours of service users in a way that minimised frustration. The way they spoke to and interacted with the people was positive, and there was a good understanding of peoples’ communication needs. Staff had been provided with training, which included specialist training such as understanding Autism, Aspergers Syndrome, managing Epilepsy, and effective communication, this provides staff with the skills and knowledge necessary to understanding and meeting the needs of service users. The Avenue offers a spacious environment in which people can choose to socialise or not, this is particularly good for people who do not like to mix too much. There is adequate room for people to move around, and private en-suite facilities mean people do not have to share and have a good degree of privacy for their personal care. The bedrooms are very spacious, brightly decorated and appropriately furnished for younger men, including having T.V. music centres, and lots of storage for personal possessions. Six comment cards were completed by people living at The Avenue, these reported satisfaction with the service provided. All service users had been supported to undertake personal care to a good standard. This included care of their hair, nails, and shaving. There was good care provided to a service user who had a fear of the dentist, and he had Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 6 benefited from new veneers on his teeth, of which he was very proud. The choice of clothes, and personal care was reflective of the service users age, gender and culture. There was a good system in place for determining what activities service users were interested in, and each had a variety of social activities engaged in regularly and in line with their peers. It was positive to see service users having opportunities to engage in every day domestic tasks that promote their independence. The response from visiting professionals involved with the care of service users was very positive. Comments such as; ‘Delighted with The Avenue, they have gone above and beyond what we could expect’. ‘Has very complex needs, now out regularly, has made friends and attending courses’. ‘Have discharged the Occupational Therapist input, because The Avenue have provided activities that he is engaging in.’ What has improved since the last inspection? What they could do better: The manager needs to ensure that any intervention plan concerning food, has been discussed, agreed and designed in consultation with the relevant health care professionals to ensure the best interests of the service user. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 7 Service users must be supported to attend hospital in the event of an accident. The manager must ensure that records accurately reflect that service users are offered this choice, and in the event they refuse, this too must be recorded. The inspector was concerned that medication self administered by service users, was not routinely audited to ensure that this arrangement is still one the service user can manage safely. Whilst there are opportunities for service users to voice their opinions on the care they receive, there needs to be a formal means of quality assurance. This should seek to obtain the views of service users, their representatives and other external professionals, and there should be systems for feeding back the outcome of this, in order to continually improve the service on offer. It was disappointing to see that previous good practice had slipped. The registered provider must ensure that monthly regulation 26 visits are carried out in order to meet the requirements of The Care Homes Regulations 2001. This is important because the provider has a responsibility to ensure that the standard of care provided at the home is monitored, and in line with service users needs. 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 The (3) DS0000016988.V306743.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 Avenue The (3) DS0000016988.V306743.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): 1, 2, 4 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have had information in a format suited to their needs, which helped them to make an informed decision about moving into the home. The individual needs and aspirations of prospective service users are assessed ensuring that they know what to expect, how care will be delivered, and ensuring needs will be met. EVIDENCE: The Manager said that the Statement Of Purpose and Service User Guide had recently been updated and copies of these documents were provided. These were both seen to be generally comprehensive documents. The format was suited to the needs of the service users accommodated this included a larger size type and pictures. Requirements made at the last inspection in relation to including details in relation to an annual holiday provided as inclusive of service users fees, is now in the Service User Guide, this will ensure service users are aware of their entitlements and can influence how they wish to use this holiday. Contracts were not examined at this visit. Copies of the service user guide, complaints information and details about the Commission were displayed on the notice boards this ensures service users have good access to information concerning them and their stay at the Avenue. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 10 Conversations with service users and six completed questionnaires confirmed that service users had sufficient information about The Avenue before they made the choice to move in. Service users new to the home are only admitted following a full assessment of their needs so ensuring that the service users expectations and aspirations can be met by the home. An admission assessment had been completed for the service user who had recently been admitted to the home, before they moved in. This included their ability to self-care, psychological, emotional, social, and health care needs. There was comprehensive information gathered over a planned lengthy introduction period, which included a management programme for risks, setting boundaries for behaviour, occupational therapy input and mental health care. Issues such as meaningful employment and or further education opportunities were explored, in line with what the service user said they wished help with. It was positive to see that the service user and other professionals were central to this process so ensuring everyone knows what to expect from the home. The visiting professional said that The Avenue had worked in partnership with them and they had been fully involved in the admission and care planning process. There had been positive improvements benefiting the service user to include activities, which had previously been difficult to engage the service user in. He had made friends, and his quality of life had improved so much that their ongoing support was not required. It is commendable to the staff at The Avenue had ‘gone above and beyond what was expected from them.’ One service user said ‘I like it here because I’m involved in planning my care, I only need support with personal care, cooking and money, I have a key-worker who I talk to and we look at what I’ve been doing and what I’d like to do. I’m hoping to do a catering course and we went to view the college.’ There is a comprehensive Admissions procedure, which is included in the Service User Guide. This ensures that all prospective service users and other relevant persons involved in the process have the information necessary to know what to expect in terms of planned admissions. The Policy sets out clearly that prospective service users have the opportunity to visit and meet staff and other service users, enjoy a meal, and be consulted about their needs and how the home intends to meet these needs, prior to the service user making a final decision. Care records showed good detail regarding a planned admission and how this was managed. This was a lengthy process suited to the specific needs of that individual, and included a trial period, a review, and the persons’ compatibility with existing service users. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 11 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, 8, 9 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Service users’ needs and wishes are well planned and reflected in their care plan ensuring staff know how to support them. There is good consultation with the service users ensuring they are enabled to make meaningful decisions about their lives and other aspects of the home. Service users are supported in taking risks as part of an independent lifestyle. EVIDENCE: The plans of two service users were assessed during the fieldwork visit. The plans detailed to a good extent the persons care and support needs and included personal goals, cultural and religious needs, diet, planned interventions, and setting boundaries. This was supported by one to one sessions with the key-worker in which goals are reviewed and options for success offered. It was positive to see that where concerns or changing needs are noted these are picked up and acted upon quickly in order to minimise the risk to a vulnerable service user. For instance a service users’ destructive behaviour was met with options or alternative means of obtaining his objective being explored with him and agreed as a way forward which would not put him at Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 12 risk. There were other good examples of enabling service users to understand how to behave in the community in a positive way within their capabilities and supporting them to understand the implications or consequences of behaviour on others. The care plans contained goals, such as ‘using and accessing local services independently’, ‘employment and education options’ ‘ engaging in weekly activities’, ‘making friends ’and ‘ keeping health care check appointments’. Care plans are generated from the assessment information and included the involvement of the service user, and relevant specialists involved in the care. Where restrictions are evident in relation to an individuals’ personal choice this was agreed with the consultant and parents in order to ensure the immediate safety needs of the service user concerned. A review undertaken by the placing authority was seen and showed that an individual had made progress, since his arrival. Comments included; ‘Settled well confident in accessing community services independently’. ‘Engaging in weekly activities’. ‘Much more relaxed has made friends and is working on his appearance’. There were weekly meetings with key-workers to support service users in meeting goals and assessing if they had been met. Several service users were able to express their views to the inspector as to how far they are consulted with regards to events within the home. They reported being involved in the redecoration of their bedrooms and the lounge. One service user said, ‘I like the service user meetings.’ Another said ‘The carpet in my bedroom by the en-suite kept getting wet so now I have a laminated floor which is much better’. This person also said ‘I have my own kettle and fridge in my room to make and keep my own drinks and snacks’. This provision is clearly in line with this persons needs and capabilities and it’s positive to see that this has been accommodated. On the day of the fieldwork visit another service user was having ‘Sky T.V.’ fitted in his room and after some problems with the instalment staff were seen to support him in resolving this with the engineers. Monthly audits carried out by the provider showed that service users views are sought, those seen for February, March and April 2006 showed that service users were asked their experiences of the facilities, standards, staffing and their key-workers. It was positive that opportunities for service users to express their faith were offered at the local church. One service user confirmed his attendance at church. A second service users records showed that cultural dietary needs had been explored. Service users living at The Avenue require varying levels of support to manage their finances. Care records detailed how service users were to be enabled to manage their money and budget. Two service users confirmed they have access to their money to buy personal goods and or cigarettes or clothes. They Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 13 were happy with these arrangements. Records sampled showed that cash balances held on behalf of service users are maintained satisfactorily and audited to ensure any mistakes are rectified. There was good information, and risk assessments in place to support service users specialist mental health needs. A plan for self-neglect, and deteriorating mental health, was evident and provided staff with good information as to recognising changes in mood and how to respond to these appropriately. The risk assessments are reviewed routinely as significant incidents, or changes occur. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Opportunities to undertake interesting activities both in the community and at The Avenue are evident ensuring service users can enjoy a meaningful lifestyle. Service users are supported to stay in touch with people who are important to them. The planned menu is varied and nutritious, but the review of risk factors associated with food and the intervention of staff must include consultation with the relevant professionals regularly, to ensure nutritional needs are met. EVIDENCE: On the day of the fieldwork visit it was positive to see that the service users living at the Avenue were all engaging in different activities. Some were out at college places, some watching T.V. or listening to music in their rooms, three people were in the kitchen deciding on what to cook for lunch, and one person was waiting for his ‘Sky’ channel to be installed. The inspector spoke with three service users at length, and checked the care plans for another three service users, in order to establish what opportunities Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 15 are available to service users that will enable them to live ordinary and meaningful lives with opportunities appropriate to their peers and level of ability. There were opportunities evident, which records showed had been developed with the service user as part of their care plan goals. It was particularly pleasing to see that staff via the key-worker system, meet regularly with the service user in order to see if their plans and goals have been achieved for the week. This ensures that opportunities are not missed, and if they are staff can determine with the individual what the obstacle was and look to rectify this. Service users informed the inspector that their individual plans included both practical skills development, as well as social and education opportunities. One service user described that he has a ‘laundry day’ to do washing ironing and putting away of clothes. He cooks meals regularly with staff support and particularly enjoys making cakes. It was positive to see that the Service User Guide gave good information to prospective service users as to what is to be offered and expected in terms of undertaking skills development and independence, this ensures that before service users move in, they have a good understanding of this. Another service user said ‘I like going to church, the cinema and occasionally swimming. I go to the service user meetings and staff took me to see the college for a catering course’. It was pleasing to see that where necessary issues relating to retirement had been explored with individuals, and that alternative social opportunities were being discussed as the service user was missing his previous occupation. Plans were also evident with another service user to begin to establish a weekly activities programme, to provide fulfilment and some structure. Employment and college options had been made available to him as had attending BITA. The Service User Guide also provides information to service users as to the type of assistance staff can provide in relation to exploring education, employment, or training interests. This is particularly useful as it allows prospective service users to make positive choices about the style or approach of accommodation and support offered. Daily records sampled, generally reflected what had been offered to service users, and what had been declined. Most service users had utilised community based amenities to include, the library, swimming, church, shopping trips for clothes, and weekly shopping trips for food, some use the pub independently. Lunches out featured well for those who enjoy this, walks, and visits to the snoozelum had also taken place. Discussions with staff confirmed that they use the daily records as a means of monitoring whether a plan is being followed or whether different options need to be explored. Service users themselves felt that they could talk to staff if they were not happy with their plan, and that service user meetings were a good way to explore social activities and planned trips. They had been to the theatre, concerts, zoo and markets, which they enjoyed. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 16 Care plans also showed that where an individual, due to specific needs such as Autism or Aspergers Syndrome does not enjoy holidays or group activities, comprehensive lifestyle objectives are set with guidance on what that person should be doing and a review date to establish how well this meets with their complex needs. Six comment cards were received from service users that reported they could do what they want to do during the day, in the evening and at the weekend. The information available suggests there are usually enough activities for service users to undertake. It was pleasing to note that service users were supported to maintain contact with their friends and relatives. Three service users told the inspector that they maintain friendships outside of the home and can come and go freely. Records showed that service users are supported to visit their families and The Avenue has its own transport to assist service users to travel. It was pleasing to see that this aspect is encouraged further by providing service users with this information in the Service User Guide, which informs them they can invite family and or friends for visits and or meals. The discussions with service users indicated that issues of privacy and independence are addressed. Service users have their own bedroom door keys, and showed the inspector their bedrooms. En-suite facilities are provided to include a toilet, sink and shower this enabled service users to use facilities within the privacy of their own rooms. A telephone is available, this is in the lounge, but staff said service users can be offered a mobile phone and access to the office to make calls; one service user was supported to phone his G.P in the office. There are no rigid rules or routines those service users observed all had their own individual plan for the day, this included domestic tasks, cooking cleaning and or social/educational commitments. The Service User Guide informs service users of house rules such as smoking, but there is no information on drinking or drug use. Food supplies are shopped for weekly and include the service users choices and assistance with the shopping. Service users said they had opportunities to plan prepare and cook meals, and this was observed on the day of the visit. A selection of menus was seen which showed that a variety of meals are on offer. Service users said they particularly enjoyed the food. Two service users went out to lunch on the day of the visit. Cultural choices have been explored and provided, one service user is Cantonese and although he has no cultural preferences, (as described by his family) he has had these foods offered. Other service users have enjoyed authentic meals both in and out of the home. One monthly review stated that some food stocks were restricted to one service user, due to ‘eating all the time, and not proper meals’. This person had a weight record, and a risk assessment for ‘self neglect including diet’. There was no indication that this intervention had been explored with other Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 17 professionals involved in his care, although it was recorded that he had been told why. The inspector was able to discuss this issue with a previous professional involved with the service user. It was apparent that the routines of the previous placement did not always allow open access to food. Consequently the living arrangements at The Avenue are new to this individual. In order to support the service user with making appropriate choices, the manager must ensure that any programme of intervention relating to diet is undertaken with consultation and agreement from other professionals for instance his G.P. Consultant or the dietician, to ensure his nutritional needs are met. This must be included in his care plan. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 18 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, 20 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Service users have personal support in the way they prefer and require. Health care is generally well planned, although one shortfall was identified for development, to ensure service users needs are consistently well planned for and met. Medication is generally well managed, which ensures service users get the right medication at the right time. Further development of the auditing system will provide better safeguards for those who self-administer medication. EVIDENCE: The Avenue accommodates service users with a range of different personal care needs. Service users ages currently range from twenty four to fifty seven years of age. Within this some people have specific health care needs relating to Epilepsy, or mental health. Service users have varying degrees of learning disability and associated needs including Autism and Aspergers Syndrome. Routines are flexible and seen to meet the needs of service users, each has a plan showing their particular routine and level of support needed, this ensures that those who require it have the structure they need and that personal care is met in a manner that is appropriate to their individual preferences, particularly where service users cannot easily communicate this. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 19 Plans to underpin service users healthcare needs had been reviewed, and contact with other care professionals was included. Tracking of appointments attended and offered was clear. One person tracked had contact with the Consultant Psychiatrist, and Occupational Therapist. His records showed that he had attended a ‘Health Check’ at the surgery and a ‘Well Man’ clinic, a Podiatrist for care of his feet and a dental appointment for his teeth. He had a hygiene chart on file, which was designed to support him with his personal care routine, which was within his capabilities. It was evident that the aids required for another service user who has Epilepsy had been assessed, and had included consent from the responsible Consultant and the parents. This ensures his immediate safety needs. The management plan for Epilepsy was incorporated into his care plan. Monitoring of seizures was being undertaken consistently. A second service user had been supported to attend the dentist, which he had had a fear of. This resulted in new veneers for his teeth, he told the inspector, ‘I’m very proud of these, and now I can go to the dentist without being scared, that’s because (staff member) took me’. The use of the homes transport ensures that those who require it have transport to appointments. This ensures that the difficulties experienced by some, do not hinder their access to healthcare facilities in the community. The inspector identified that one person tracked had a record of weight taken on admission. Regular weight monitoring is good practice and ensures any concerns are identified quickly. One person tracked had a previous mental health problem. The care file showed that relevant specialist support was retained. The inspector had one concern relating to the management of accidents. One service user had a fall two days previously, and had sustained nasty facial abrasions, which looked quite sore on the day of the visit. On checking his records it was good to see that a ‘body chart’ had been completed identifying where the injuries were, and that an accident record was made out. The daily records did not state that he had been offered or advised to go to the Accident and Emergency Department, or whether this had been refused. It is important that service users are supported with accessing NHS Healthcare facilities in line with their needs, and that accidents are followed up and recorded to show what steps were taken to ensure the wellbeing of the service user. This was discussed with the manager. The service user was supported to make a G.P. appointment that day as his injuries were ‘weeping’. The service history for the home did show that on other occasions, injuries to service users were followed up by attending the hospital. Medication management was generally good. A record of medication received, administered and returned had been maintained. Protocols for as required (PRN) medication were in place. A homely remedies policy was evident, and each record had a photograph of the service user to aid identification. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 20 The audit of medication was accurate, and the security safe. The manager carries out monthly in-house audits of medication to ensure procedures are followed and mistakes rectified, this is good practice and ensures the safe administration of medicines to service users. However the in-house audit did not include those medications administered by service users themselves, and this needs to be included to ensure service users are managing this aspect safely. Some service users spoken with had good information as to their health care needs to include the reasons why they were on medication, and what it was for. They were happy with the support they had. One service user said, ’I have a tiny dose and it won’t be forever it just calms me down.’ Another said ‘Staff support me to make G.P. appointments and I can see the G.P. by myself but sometimes I like the staff with me.’ Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 21 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, 23 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The Complaints procedure has been given a good profile ensuring service users and family know how to raise concerns. Service users finances are managed well, ensuring they are protected and have access to their money. There are arrangements to protect service users from abuse, neglect and self-harm. EVIDENCE: The complaints procedure was not assessed at this inspection, but the preinspection questionnaire completed by the manager prior to the visit said this was reviewed in 2006. The Commission has not received any complaints with regards to this service, since the last inspection. It was positive to read in six of the comment cards that service users were aware of how to make a complaint. Copies of the complaints procedure are made available to service users, each had a copy, and these were also displayed on the notice board and in the Service User Guide. Discussions with service users demonstrated that they knew how to access the complaint procedure, and one confirmed that he had. The Avenue recently had to implement procedures relating to theft of money this is currently being handled by the police. The arrangements for safeguarding service users finances include appointees by social services, and supporting service users to manage their monies. Appropriate arrangements for money to be paid directly into service users accounts are in place. Records relating to the personal allowances and Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 22 expenditure are maintained for each transaction. Daily financial audits are carried out to ensure that accounts are passed from shift to shift with no discrepancies. There are arrangements in place for named key holders. One person tracked, had had their finances managed by their parents as this has been a long-term arrangement. It was recognised that this aspect of care will need to be explored at subsequent reviews. The care plan for one service user showed that interventions to manage behaviour that can challenge are explored. Strategies were recorded to support the service user appropriately. The policy regarding reporting and responding to allegations of abuse was not assessed. It was positive to find that staff had been provided with Vulnerable Adult awareness training. This was evident in the two files sampled. Staff spoken to had a good awareness of what action to take if they suspected abuse, and this was good to see in terms of protecting vulnerable people. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 23 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, 25, 26, 27, 28, 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Service users live in an environment that is appropriate to their particular lifestyle and needs, as well as being homely, clean and comfortable. EVIDENCE: The design of the premises are such, that adequate room is provided in all areas of the home to enable people to choose to what extent they socialise with peers, this is particularly important for people who through reasons of their disability find socialising and group living, difficult. Nobody currently uses mobility aids. There is a mobile ramp for accessing the home, this can only be used for the rear entrance, it is currently not utilised for service users. Service users have their own en-suite facilities suited to their needs. There is a main staircase that opens onto a landing, it was good to see that the banister is of a height that would prevent or minimise the risk of service users falling over it and down the stairs. The standard of décor and furnishings is good, since the last inspection a number of bedrooms have been redecorated to the service users’ individual choice. The communal areas were spacious comfortable and clean, although the lounge carpet was stained and needed a clean. It was positive to find that work to redecorate the empty bedroom and Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 24 fit a new shower, sink, and toilet had already commenced whilst this room was vacant. Seven service users showed the inspector their bedrooms, these were spacious, and very individual, great storage facilities and bright. There were posters on the ceilings, good use of shelving and gender appropriate curtains and quilt covers. Service users were very pleased with their rooms, and it was evident that staff do support them in having a personal space individual to them and reflective of their age and interests. Service users had a key to their bedroom and a lockable facility in which to keep valuables. Where some damage had occurred due to behaviour repairs were noted ensuring that the environment is kept safe and comfortable for service users. There are two lounges and a dining room enabling service users plenty of space in which to do activities and socialise. A smoking area has been identified in the garden house outside, which offers service users a choice. The kitchen, laundry and communal areas were viewed. Cleanliness standards were good. Care staff undertakes the domestic tasks, and service users are involved in this. Food hygiene and infection control measures were followed on the day when the lunch meal was prepared and laundry undertaken. All staff had received food hygiene and infection control training. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 25 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, 34, 35, 36 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Staff are trained to the required standard and supported to meet the service users specific needs. Staff are robustly screened prior to starting work providing safeguards for vulnerable people. EVIDENCE: The staff team is mainly well established, and consists of people who have got to know the service users well over a period of years. There have been three new staff since the last inspection, these have been working in the home for a number of months and are settled into their role. Service users describe staff as approachable, supportive, and helpful to them. The staff on duty actively engaged with service users, supporting them to undertake their daily tasks. The interactions between staff and those service users who have difficulty in communicating their needs was good, one service user was getting frustrated with the T.V. and staff were responsive in calming and diverting him. Staff training records, identified that a good baseline of training had been provided, which met with the needs and specific conditions of the service users, this included; training in Epilepsy, Aspergers, Autism, effective Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 26 communication, and managing behaviour that challenges. Further specific training was planned in depression and mental illness. Mandatory training had been completed by staff to include fire safety, first aid, food hygiene, health and safety, infection control, safe handling of medicines, all training is undertaken within the LDAF framework, (Learning Disability Award Framework) which is accredited to provide underpinning training for staff working with people with specific needs. The pre-inspection questionnaire stated that 75 of staff had achieved NVQ level 2 and above. Discussions with staff identified that they had a good understanding of the specific needs of service users, to include their methods of communication, and understanding and anticipating behaviours, this ensured they had the skills necessary to support the individual in a positive manner. Two staff recruitment records were examined and identified that these staff had been robustly screened prior to them commencing work in the home. Key pieces of documentation including ID, photo; health declaration and confirmation of CRB clearance, completed application form and two references, were on file. The system in place for recruiting staff ensures that service users are protected by the home’s practice. Induction training had taken place for the latest members of staff. One person interviewed felt the induction was thorough and covered the principles of care, safe working practices, the role of the worker and the particular needs of the service user. A learning agreement was evident to show training identified and planned for the individual this ensured that training met with the aims and service users needs. Staff supervision records indicated that supervision is planned and takes place monthly. The format was to a good standard, and covered all aspects of the staff members’ performance and training, this ensured that staff are supported to translate their training into good care with the service users benefiting. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 27 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, 42 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Service users do benefit from a well run home, but there are some aspects that require further development. Service users are consulted, but there is no formal feedback to demonstrate how this underpins the development of the service, and provide service users and others involved with the home, with the confidence that their views are central to this. Monthly checks by the provider have not been consistent, this could mean that problems with the service may not be identified and acted upon quickly enough to prevent potential harm to service users. There are generally good arrangements to ensure the health and safety of service users and staff, although improvements in the auditing of practices would enhance this further. EVIDENCE: The registered manager said she has completed her NVQ level 4 in management and care and is waiting for her certificate. Her Registered managers’ award is completed and waiting confirmation. Upon confirmation the Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 28 Commission will need to issue a new registration certificate with the condition of registration that relates to the managers’ training, removed. She has several years experience of caring for people with a learning disability and managing a staff team. She has undertaken periodic training to ensure she updates her skills and knowledge in meeting the needs of service users. In January 2005 Kelso Care Consortium Ltd commenced the Investors In People programme and successfully gained the award in June 2006. The manager said that the organisation is working towards a quality assurance programme. The Service User Guide gives some information to service users as to how the home will seek to obtain their views, a questionnaire is provided. The manager said that these have not been analysed for feedback. Service users meetings, staff meetings and staff supervision is established, and provides a platform for reviewing the care practice and enabling service users and the staff team to influence the way the home is run. It would be positive to see a formal quality assurance system in place involving service users and other stakeholders’ views. Regulation 26 visits have not been undertaken since May 2006, and these must be resumed with urgency in order to meet requirements. There was a valid certificate of liability insurance, and registration on display. The Pre-inspection questionnaire returned prior to the fieldwork identified that servicing and maintenance of equipment had been undertaken, as is required. There are good arrangements to ensure the health and safety of service users and staff. During the inspection records regarding health and safety tests including; fire safety, water temperatures, accident records, electrical and gas safety certificates, and food stock, storage and preparation of food, risk assessments were seen. Risk assessments were evident for the premises, and safe working practices such as manual handling, and the control of substances hazardous to health (COSHH). All radiators were covered (a risk assessment was in place for rooms 3,4,and 5, stating the reasons for no radiator cover), to prevent the risk of scolding or burning, and showers are fitted with water temperature regulators to minimise the risk to service users. Risk assessments for known disabilities, or individual needs were in place to ensure that appropriate support and control measures are offered to service users. Auditing of service users who self medicate must be undertaken to ensure their continued safety in this area. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 X 4 3 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 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X X 2 2 Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 17(1)(a) S3(3)(m) Requirement The details of any plan or intervention, relating to nutrition or restriction of food, must be agreed with professionals and recorded in the service users care plan. The manager must ensure that daily records reflect that treatment or access to healthcare professionals is offered. This must include service users being asked about attending hospital for treatments. The audit of medicines must include those that are being self administered by service users. The carpet in the lounge requires cleaning. The registered person will provide a system (Quality Assurance System) for reviewing and improving the quality of care in the home. The system will provide for consultation with service users and their representatives. Regulation 26 visits must take place monthly and a report DS0000016988.V306743.R01.S.doc Timescale for action 12/11/06 2. YA19 13(1)(b) 12/11/06 3. YA20 12(1)(a) 12/11/06 4. 5. YA24 YA39 23(2)(d) 24(1)(a,b,c) 12/11/06 20/10/06 6. YA43 26(3) 26(4)(c) 12/11/06 Avenue The (3) Version 5.2 Page 31 prepared on the conduct of the home 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 YA16 YA37 Good Practice Recommendations It’s recommended that the rules regarding drinking be set out in the next review of the Service user Guide. The manager should send formal confirmation i.e. a copy of her Registered Managers certificate and NVQ level 4 qualifications. A new certificate of registration will be issued removing the condition relating to the managers’ training. Avenue The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 The (3) DS0000016988.V306743.R01.S.doc Version 5.2 Page 33 - 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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