Inspection on 25/06/07 for Avenue The (3)

This inspection was carried out on 25th June 2007.

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 The (3) 11/09/06

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 Key Unannounced Inspection 25th June 2007 12:00 Avenue The (3) DS0000016988.V343421.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.V343421.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.V343421.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.V343421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 11th September 2006 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. There is no wheelchair access to the front of the building people need to be able to negotiate the steps to the door. Currently people who live in the home 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 the people who live there to make full use of it. This is very well maintained with people who live at the home actively involved in potting and planting, it is a lovely place to enjoy. 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.V343421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced visit was undertaken by one inspector over a period of one day to include the lunchtime and evening mealtimes. There were eight people in the home on the day of the visit, one person in hospital and one vacancy. The inspector also met with one person who was visiting with a view to moving in. Information was gathered from speaking with people who live at the home, a visiting professional and staff who work there. Care, health and safety and the arrangements for medications were reviewed. Some staff files were checked, this included the training they had received. Staff were observed whilst carrying out their duties. A partial tour of the premises was carried out. Prior the inspection the manager had been sent an Annual Quality Assurance Assessment. The purpose of this document is to obtain information about the services provided. Unfortunately at the time of writing this report this information had not been received due to sickness of the manager and the postal delays. However previous history of this home was considered from the last questionnaires completed by the manager. Questionnaires were sent to selected professionals and relatives but no completed returns were received. The views of the people who live at the home were also obtained using a survey known as “Have your say about”. The information from these was taken into consideration as part of the inspection process. At the conclusion verbal feedback was given the manager. It was pleasing to note that all of the requirements made from the previous inspection had been addressed. What the service does well: The way that staff interacted with the people was positive, and there was a good understanding of peoples’ communication needs. The complex needs of some people mean that staff need skills in anticipating behaviours in a way that minimises frustration. They do this well. Staff are trained in understanding specialist needs such as Autism, Aspergers Syndrome, mental health and depression, managing Epilepsy, and effective communication, which means people who live at the home are cared for by a skilled workforce. There is 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. Private ensuite facilities mean people do have more privacy and independence for their personal care needs. The bedrooms are very spacious, brightly decorated and Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 6 appropriately furnished for the younger man, including having T.V. music centres, and lots of storage for personal possessions. Five ‘Have Your Say’ comment cards reported satisfaction with the service provided. All of the people who live at The Avenue were supported to undertake personal care to a good standard. Their appearance was reflective of their age, gender and culture. There was a good system in place for determining what activities people wish to engage in, and each had a variety of social activities. Some people had been actively supported with educational and employment opportunities. Positive comments from people who live in the home were; ‘I’ve learned a lot here how to cook, clean look after my own money’. ‘I know I sometimes complain but really the staff help me a lot.’’ I have lots to do, I really like cooking, and we go on holidays and trips.’ There is a good emphasis on promoting independence. This service has a consistently good record of positive comments from professionals who work closely with the home. The following comments have been shared with the Commission from previous visits to the home. The inspector found at this visit that good standards had been maintained. ‘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? Guidelines for the support people need to maintain their nutrition have been put in place to ensure people eat well and stay well. Daily records show what steps have been taken to encourage people to seek treatment. These now clearly show where the individual has refused such advice. The audit of medicines now includes those people who look after their own medication, this means that staff can quickly identify if someone is having difficulties and can rectify this to ensure their wellbeing. There has been some redecoration to some parts of the home, new furniture, and carpets cleaned. The facilities provide a nice environment for the people who live there. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 7 There has been progress in providing a system (Quality Assurance System) for reviewing and improving the quality of care in the home. This has included seeking the views of the people who live there. The consistency of monthly visits by the responsible individual has improved, the standards in the home are regularly checked so that the people living there are having the service they want and need. 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. Avenue The (3) DS0000016988.V343421.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.V343421.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, & 4.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home which helps them to make an informed decision about whether the service is right for them. This information is available in a suitable format to assist people in understanding what is available. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. EVIDENCE: The Service User Guide, Statement Of Purpose and Complaint Procedures are given to people who may wish to move into the home. Information in these was seen to be relevant and the format was suited to the needs of the people accommodated, this included a larger size type and pictures making them easier to understand. These were seen to be generally comprehensive documents. Copies of these were also displayed on the notice board this ensures people have good access to information concerning them and their stay at the Avenue. Information taken from five surveys known as ‘Have Your Say’ confirmed that the people who live at the home had sufficient information about The Avenue before they made the choice to move in. Some people commented that they based their decision more on their experiences during their trial visits rather than written information given to Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 10 them. This is positive because it shows that this service has a number of ways in which it aims to engage with people in a meaningful way. ‘Information Meetings’ also take place with people who are intending to move to The Avenue and their families, this ensures that they are fully informed about what the service can offer them and gives them an additional opportunity to make an informed decision. It was positive to see that records sampled reflected a good level of consultation with people prior to them moving in. People new to the home are admitted following a comprehensive assessment of their needs so ensuring that their expectations and aspirations can be met by the home. The records for two people undergoing assessment were looked at these included their ability to self-care, psychological, emotional, social, and health care needs. This information was gathered over a planned lengthy introduction period. A management programme for known risks, setting boundaries for behaviour, occupational therapy input and mental health care was also in place ensuring everyone knows what to expect from the home and how best to deliver the care needed. Issues such as meaningful employment and or further education opportunities were explored, in line with what the person said they wished help with. It was positive to see that the both the person being offered care and other professionals were central to this process so ensuring everyone knows what to expect. On the day of the visit the inspector met with one individual who was having a visit that evening, and the member of staff from the previous placement who was supporting him. He was very positive about his visits and had undertaken some previously, he said he had got to know the staff and that they were nice to him, he was particularly pleased that his favourite tea was on the menu that evening. The inspector spoke with the staff member on duty who said that they had planned his favourite meal because he had said how much he loved ‘burgers in a bun with chips’. This was a particularly nice touch that clearly meant a great deal to him when he said, ‘It’s my favourite tea……… they remembered’. The staff member supporting him said that The Avenue had worked in partnership with them and they had been fully involved in the introductory visits and that good efforts were made to welcome him, support him and make him feel at home, she said ‘He loves to come, gets really excited.’ There is a comprehensive Admissions procedure, which is included in the Service User Guide. This ensures that the individual and other relevant persons involved in the process have the information necessary to know what to expect in terms of planned admissions. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 11 The Policy sets out clearly that those intending to move into the home have the opportunity to visit and meet staff and other people living there, enjoy a meal, and be consulted about their needs and how the home intends to meet those needs, prior to them making a final decision. It was positive to see that the persons’ compatibility with existing service users is taken into account. A second care file was looked at and this showed that an assessment was being carried out to identify the persons’ needs and explore how these could be met. The information seen here was comprehensive and reflected that information meetings had taken place, introductory visits had been made and that a high level of consultation with other professionals had been undertaken. Specialist and clinical guidance was included in the assessment and care planning process to ensure that the home could effectively meet the persons’ needs before being offered a place. The daily records for this person were looked at and it was positive to see that the specialist needs of this person are reflected in his daily records so that it is clear how staff respond to these needs and the persons’ response to the care offered. This is particularly important where the individual has a range of diverse needs to include threats of self-harm, aggression, borderline personality disorder, paranoid features and suicidal tendencies. There were strategies in place to show exactly how staff could recognise any of these tendencies, and the triggers to them. Directions to staff to minimise risks were specific and this ensures that everyone knows how to meet the individuals’ needs in a safe and caring manner, enhancing the consistency and continuity of care. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 12 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): 6,7,8,and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive support plan is available for each person living in the Home detailing how his needs will be met. The needs and wishes of people are well planned, consistently followed and ensure people are enabled to make meaningful decisions about their lives and other aspects of the home. People are supported in taking risks as part of an independent lifestyle. EVIDENCE: The people who live at the home have a range of complex needs, some requiring a great deal of care and support in order to keep them safe. It is therefore essential that the care plan say exactly what needs to be done to meet the individual’s need. Two care plans were looked at to case track how these needs are identified and met. The two people chosen have a range of complex needs to include a learning disability, Aspergers’ Syndrome, Epilepsy, mental health with threats of self-harm, aggression, borderline personality disorder, paranoid features and suicidal tendencies. Some communication difficulties were also evident as was healthcare needs. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 13 There was ample evidence of the involvement of external professional to include clinical guidance from the Community Psychiatric Team, Social Worker, G.P., and Weight Clinic. The plans detailed to a very good extent the persons care and support needs. Care plans were supported with extensive risk assessments which identified specific health care and safety risks such as not eating, threats to self harm, incontinence when mental health deteriorates, behaviour strategies for dealing with aggression and the approach to use to diffuse anxiety. There was also very well written extensive lists of activities, likes and interests to show the strengths of the person and try to work on engaging them in activities meaningful to them which would minimise the complex behaviours. Care plans included personal goals and aspirations. For instance ‘enjoys the cinema’. The daily records were looked at and showed that trips to the cinema had taken place. Other goals relating to the development of skill were evident and the daily records showed when these opportunities had taken place, and the persons’ response to this, i.e. whether or not they enjoyed it. Managing money, and seeking employment were reflected in some personal goals and these were commented on in the daily records so that there was an ongoing review of the progress made. Cultural and religious needs were evident and plans stated the individuals’ religion and culture. The home has provided a Halal diet in keeping with the persons’ faith. Records and provisions showed these needs were met. Care plans are supported by one to one sessions with the key-worker in which goals are reviewed and options for success offered. 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 reviewed regularly to ensure the changing needs of people are being met appropriately, the person being cared for, family and other relevant professionals are involved in this process. Several people who live in the home 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 dining area, holidays and activities. The inspector spoke with seven of the eight people present and all were positive in their responses. One told the inspector about his bedroom flooring, ‘The carpet in my bedroom by the ensuite kept getting wet so I had a laminated floor which is much better, but my room is going to be redecorated and I’m having new carpet as well’. This person also has their own kettle and fridge in the room to make and keep their Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 14 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. Monthly audits carried out by the provider showed that the views and opinions of the people who live at the home are sought with a view to improving the service. Comments regarding their experiences of the facilities, standards, staffing and their key-workers were recorded. The people living at The Avenue require varying levels of support to manage their finances. Care records detailed how they are enabled to manage their money and budget. Two people confirmed they have access to their money to buy personal goods and or cigarettes or clothes. They were happy with these arrangements. Records sampled showed that cash balances held on behalf of people are maintained satisfactorily and audited to ensure any mistakes are rectified. On the day of the fieldwork visit one person was being supported with budgeting for his holiday but he also wanted to increase his T.V. channels, all the options were being put to him in terms of the direct debit and whether or not his weekly funds would accommodate this purchase. It was positive to see staff trying to support him in making an informed choice 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. This ensures that people have the support and treatment they need to stay safe. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 15 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,and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a range of interesting opportunities that include employment and education ensuring people can enjoy a meaningful lifestyle that is in keeping with their peers. People who live in the home are supported to maintain friendships and relationships with people who are important to them. Meals are varied, nutritious, and include a review of risk factors associated with food, which ensures nutritional needs are met. EVIDENCE: On the day of the fieldwork visit eight of the people who live there, were present, with one person in hospital. That evening the inspector also met with a gentleman who was hoping to move into the home and was visiting for tea. The Avenue is a busy place, the people who live there all actively engage in a varied activity plan designed by them and the staff and based on their preferences. People were engaging in different activities some were out at Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 16 college places, some watching T.V. or listening to music in their rooms, one person was in the kitchen deciding on what to cook for lunch, and one person was talking to the manager about budgeting for his holiday and his T.V. channels. Another person was supported to attend the Asthma clinic. The inspector spoke with all but one person who lives at the home, and checked the care plans for three people in order to establish what opportunities are available to enable individuals to live ordinary and meaningful lives with opportunities appropriate to their peers and level of ability. The Service User Guide informs people wanting to move into the home of what is to be offered and expected in terms of undertaking skills development and independence training, this ensures that before people move in, they have a good understanding of this. It also provides information 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 people to make positive choices about the style or approach of accommodation and support offered. The Avenue operates a key-worker system where bye the staff member meets regularly with the individual 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. Care plans included both practical skills development, as well as social and education opportunities. For instance one described a ‘laundry day’ to do washing ironing and putting away of clothes. Another set cooking goals so the person had identified days for shopping, preparing and cooking meals. One person recently retired was missing his previous occupation. His records showed that alternative social opportunities were being discussed and put in place. Each person has a weekly activities programme, to provide fulfilment and some structure. Employment and college options had been included. In discussion with one person he said that staff supported him with his job applications and were helpful with his wages and budgeting. Daily records sampled, reflected what activities had been offered and what had been declined. Most people 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. Staff said they use the daily records to monitor whether a plan is being followed or whether different options need to be explored. The inspector found that the daily records did correspond with the care plan goals. Some people told the inspector that they could talk to staff if they were not happy with their plan, and that house 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. Information from the ‘Have Your Say’ questionaires indicated Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 17 that the people who live at The Avenue have good opportunities to engage in activities of their choosing. 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. The information available suggests there are usually enough activities for people to get involved in ensuring they have a varied and fulfilling lifestyle. Contact with friends and relatives is maintained people who live in the home said that they maintain friendships outside of the home and can come and go freely. Records showed that people who live there are supported to visit their families and transport to support them with this is provided. Facilities in the home enhance privacy and independence the people who live there have their own bedroom door keys, and en-suite facilities enabling them to use facilities within the privacy of their own rooms. A telephone is available in the lounge and a mobile is available for better privacy. There are no rigid rules or routines the people who live in the home were observed doing domestic tasks, cooking cleaning and going out on social activities, it was relaxed and flexible. They said they choose the times they go to bed get up and the clothes they wear. Food supplies are shopped for weekly by staff and the people who live in the home. A selection of menus was seen which showed that a variety of meals are on offer. Meals favoured highly in the estimations of the people who live in the home. Cultural choices have been explored and provided, to include Cantonese and Halal. People who live in the home said they have enjoyed other authentic meals both in and out of the home. Both the lunchtime and evening meal was observed. The people who live at the home were actively involved in the preparation and serving of this. Several people commented that they really enjoy the food. The portions of food were plentiful for those with a bigger appetite. No one currently requires assistance to eat, however there is a system in place to monitor some individuals who have known difficulties with their diet, this was seen to be done in a sensitive manner. Since the last fieldwork visit an intervention plan has been put in place for one person where there is a tendency for ‘self neglect including diet’. This plan follows clinical guidelines and ensures the nutritional needs of the person are met. Avenue The (3) DS0000016988.V343421.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19, & 20. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service have good personal support in the way they prefer. Health care is well planned; ensuring peoples’ needs are consistently met. Medication is well managed, which ensures people get the right medication at the right time, and the auditing system provides further safeguards for those who self-administer medication. EVIDENCE: The Avenue accommodates people who have a range of personal care needs. Ages currently range from twenty four to fifty seven years of age. Within this some people have specific and complex health care needs relating to mental health. All of the people have varying degrees of learning disability and associated needs including Autism and Aspergers Syndrome. Routines are flexible and seen to meet the needs of the people accommodated, 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 an individual cannot easily communicate this. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 19 Healthcare plans had been reviewed and updated providing a good record of the changing needs of the person. Contact with other care professionals was included, and there were specific well-written clinical guidelines to support staff in maintaining the health of the individual. Records were well organised making it easy to track appointments and treatment, for instance contact with the Consultant Psychiatrist, and Occupational Therapist. Records showed attendance at a ‘Health Check’ and ‘Well Man’ clinic. Some people had a hygiene chart on file, which was designed to support them with their personal care routine. One person who has Epilepsy had a management plan, which incorporated monitoring of seizures. This record was consistently maintained providing a good overview of his condition. Consent from the responsible Consultant and the parents for treatment was also evident which ensures his immediate safety needs. Staff records showed that staff had received specific training in relation to administering life saving medication. The Avenue provides transport for people who live in the home, which ensures that those who require it have transport to appointments. This means that the difficulties experienced by some, do not hinder their access to healthcare facilities in the community. The inspector identified that one person tracked has a history of rapid weight loss; records were evident to show how this had been explored with the relevant health professionals and was being monitored by staff at the home including maintaining a record of weight. Regular weight monitoring is good practice and ensures any concerns are identified quickly. One person tracked had significant mental health needs. The care file showed that a range of relevant specialist support was being utilised, which is in line with his original assessment of needs. This ensures he has the continuity of care that is needed to maintain good mental health. It was especially good to see that the daily records are well utilised to monitor how he responds to the care offered to him, and enable staff to monitor any mood changes or any indication that he is deteriorating allowing them to seek professional support without delay. Another person has a tendency to fall over more frequently when their mental health deteriorates because they walk with their head held low. This is commented in daily records and key worker sessions and a referral was made back to the consultant to review medication. The management of accidents is good, a ‘body chart’, is filled in to identify the injuries and an accident record specifies the cause of the accident. A minor shortfall noticed at the previous fieldwork visit has now been addressed. Staff now record in the daily records whether the individual has been offered or advised to go to the Accident and Emergency Department, or whether this had been refused. It is important that records reflect accessing NHS Healthcare facilities or refusing this. This shows what steps were taken to ensure the wellbeing of the person. Records at this visit confirmed that this has been implemented. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 20 Medication management was 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 person to aid identification. 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 people who live in the home. At the previous fieldwork visit it was noted that the in-house audit did not include checking those medications administered by the person themselves, only those that were administered by the staff. The manager has now rectified this which ensures that those people looking after their own medications are managing this aspect safely. It was positive to note that many of the people who live at the home have been well informed as to their healthcare needs. They said that staff talk to them about the importance of their medication, the reasons they are on it, and what it does including any side affects. One person said he knows when he needs his medication because he feels ‘funny and excited and can’t relax’ but his medication helps him to do the things he wants to do. Avenue The (3) DS0000016988.V343421.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. 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 Complaints Procedure has been given a good profile ensuring people know how to raise concerns. It is accessible and gives clear instructions for people to follow if they wish to make a complaint. The home has systems in place to protect people from the risks of abuse. The arrangements in place for the management of peoples’ finances ensure they are fully protected. EVIDENCE: The complaints procedure was available and on display on the notice board and people who live in the home have a copy in their bedroom. The complaints log was looked at and no complaints had been received. CSCI have received no complaints about this Home in the last twelve months. An easy read complaint format was available. It was positive to note that people who live in the home were aware of how to make a complaint. Discussions with them demonstrated that they knew how to access the complaint procedure, and one confirmed that he had. The ‘Have Your Say’ questionnaires indicated that people are given information as to how to make a complaint and were happy that staff would respond to this. Multi agency procedures advising staff what to do and who to contact were available in the office. Staff supervision files and the training matrix reflected Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 22 that staff is regularly updated on these procedures to ensure they know what to do in the event of an incident occurring. A copy of the whistle blowing policy was seen and the manager said this has been made available to all staff that work in the Home. Staff spoken with had a good understanding of emergency procedures and Protection procedures they were able to identify where they would be able to access further information and guidance should this be needed. The training matrix was looked at and showed that training opportunities are well organised and planned in the calendar thus ensuring staff have regular updates regarding the protection of vulnerable people. There is a system in place for the logging and recording of regulation 37 incidents, which are reportable to CSCI. This ensures the regulatory body is informed of significant events involving people living in the Home and action taken by the Home to ensure peoples welfare and safety is protected. Receipts and documentation for safeguarding peoples’ finances were looked at, some people have appointees by social services, and a good proportion of people are supported to manage their own monies. Appropriate arrangements for money to be paid directly into individual accounts are in place. Records relating to the personal allowances and 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, explained the support he had from staff to manage his money. It was evident that he is helped to budget and exercise decisions on how he uses his money and the consequences of running out. There is a good system in place to ensure that financial responsibility is recognised as that of the individual and this aspect of care is explored at subsequent reviews. Some of the people living at the home have behaviours that can be difficult. Reactive strategies were in place that stated how staff respond to and manage individual’s behaviours. One person’s strategy identified him as having Aspergers Syndrome and gave a very good description of how staff should support him, how to communicate and what signs to look for such as anxiety, and shouting. There was a good description of the triggers that could lead to frustration such as, lack of sleep, boredom, lack of money. Staff had good written intervention strategies to guide them in their response such as company, activity, a drink or a cigarette. The training matrix showed staff use low arousal techniques based on Studio III techniques of physical intervention to manage individuals’ behaviours. Staff was well informed of the techniques to use. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 23 The combination of training, skill and experience, ensures that staff can reduce the individual’s anxiety, this means a minimising of aggression, and an improved possibility of meeting the persons’ complex needs. Staff training records sampled showed that staff had received training in adult protection and the prevention of abuse. This is positive in terms of protecting vulnerable people. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 24 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): 24,25,26,27,28, &30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Avenue has facilities that are well suited to the needs of the people accommodated. The maintenance and redecoration programme ensures Improvements have been made to the physical environment so that it is a nicer, more comfortable and homely place for people to live. 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. People who live at the home have their own en-suite facilities suited to their needs. There is a main staircase that opens onto a landing, it was noted on the Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 25 previous fieldwork visit that the banister is of a height that would prevent or minimise the risk of someone falling over it and down the stairs. The standard of décor and furnishings is good, since the last fieldwork visit a number of bedrooms have been redecorated to the individuals’ choice. The communal areas were spacious comfortable and clean, the lounge carpet has been cleaned since the last visit. The dining room was being redecorated at the time of this visit, and new chairs and tables suited to the needs of the people who live there have been purchased, this will enhance the environment further for the people who live there. The people who live there gave the inspector a tour of bedrooms. They were pleased to show 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. It was evident that staff supports people well in having a personal space individual to them and reflective of their age and interests. Individual people showed the inspector their key to their bedroom and the lockable facility in which to keep valuables. There is a good maintenance system in place that ensures damage to the premises due to behaviour is repaired without delay ensuring that the environment is kept safe and comfortable for the people accommodated. There are two lounges and a dining room enabling people plenty of space in which to do activities and socialise. A smoking area has been identified in the rear garden, which offers people a facility. The kitchen, laundry and communal areas were viewed. Cleanliness standards were good. Care staff undertakes the domestic tasks, and support people to develop skills in domestic tasks such as cooking, laundry and cleaning. The standard of hygiene and infection control measures were seen to be good as observed during both the lunch and evening mealtime. Staff records showed all staff had received food hygiene and infection control training, so equipping them with the skills necessary to undertake these tasks safely. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 26 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 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff is available in sufficient numbers to enable them to meet the needs of people who live at the home. Staff has good training opportunities to provide them with the knowledge and skills to carry out their roles effectively. Robust screening of staff prior to starting work provides safeguards for vulnerable people. EVIDENCE: The staff team is mainly well established, and consists of people who have got to know the people who live in the home, over a period of years. There have been two new staff since the last fieldwork visit, these have been working in the home for a number of months and are settled into their role. Review of the staffing rota suggested that there are above the required staffing ratios, which ensures that the complex needs of people who are cared for are well met. This staffing level also ensures that the people who live there can be actively supported to engage in a range of activities both within and external to the home because they have the support they need, this promotes a good lifestyle in keeping with the youth of the current people accommodated and their desire to engage in leisure, work and adult education opportunities. The Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 27 staffing level also ensures that care staff can concentrate on their roles of delivering personal care and ensuring that health needs are being met. Care staff also undertakes the cooking and domestic duties and support people in the home to develop skills in these areas. The separation between the care and domestic duties is well organised and does not compromise one or the other. The staff members are described as approachable, supportive, and helpful, and were actively engaged with the people who live there, supporting them to undertake their daily tasks. The interactions between staff and those who have specialist communication needs, was good. Staff has the skills to communicate effectively with people living in the Home. Staff training records, identified that a good baseline of training had been provided, which met with the specific conditions of the people being cared for, this included; training in Epilepsy, Aspergers, Autism, effective communication, and managing behaviour that challenges. Specific training has been provided in depression and mental illness, which means staff, can effectively understand and care for someone with these needs. 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. At the last fieldwork visit the pre-inspection questionnaire stated that 75 of staff had achieved NVQ level 2 and above. This is impressive and ensures that the home has a skilled workforce. Staff members spoken with had a good understanding of the specific needs of the people they care for, 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 vulnerable people are protected by the home’s practice. Induction training had taken place for the latest members of staff. The induction was thorough and covered the principles of care, safe working practices, the role of the worker and the particular needs of the people who live in the home. A learning agreement was evident to show training identified and planned for the individual this ensured that training met with the aims of the home and the needs of the people accommodated. 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 Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 28 to translate their training into good care which benefits the people who live there. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 29 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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a well run home. The systems ensure that the safety and wellbeing of people living in the Home is promoted and protected. Opportunities for people to contribute their views to the running of the Home have been further developed and demonstrate that the views of people living there are central to this. Monthly checks by the provider have improved ensuring that problems with the service are identified and acted upon quickly enough to prevent potential harm to people. EVIDENCE: Since the last fieldwork visit the registered manager has completed her NVQ level 4 and has the Registered Managers’ Award, the 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 Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 30 updates her skills and knowledge in meeting the needs of people who have complex needs. 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 people who live in the home as to how the home will seek to obtain their views. At this fieldwork visit the inspector saw questionnaires that were used to survey the views of people who live in the home. These were comprehensive and provided a great deal of information as to the experiences of the people who live in the home. The outcome of these was overwhelmingly positive; some people said ‘the accommodation is excellent. ‘staff attitude is positive they are helpful’. ‘Activities are varied and always available which I enjoy’. ‘We get help with managing our money, and learning new skills like cooking.’ The manager said that these have now to be analysed and any action points shared with the people who live in the home. This shows that the future plans for this home have been progressed since the last fieldwork visit, with the views of the people who are accommodated being central to this. There has been good progress in establishing a formal quality assurance system involving stakeholders’ views. Regular meetings for both the people who live in the home, and staff and staff supervision take place. Records of these show that there are good platforms established which provide a platform for reviewing the care practice and enabling the people accommodated and the staff team to influence the way the home is run. Regular monthly audits known as regulation 26 visits are carried out and a summary of these reports is sent to CSCI office thus ensuring that the provider does take responsibility for monitoring the Home. Copies of these reports were in the Home at the time of the fieldwork. This aspect has improved since the last fieldwork visit and now meets with requirements. There are good arrangements to ensure the health and safety of people living in the home and staff. Records relating to 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 people using them. Safety checks and regular testing and service of equipment protect the safety and well being of people living at the Home. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 31 Risk assessments for known individual needs were in place to ensure that appropriate support and control measures are offered to people who need this to ensure their safety. Auditing of medicines managed independently by people who live in the home has been introduced as required at the last fieldwork visit. This will ensure people who self medicate have the right support to ensure their continued safety in this area. Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 32 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 3 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 3 25 3 26 3 27 3 28 3 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 3 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 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 33 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard YA16YA16 Good Practice Recommendations It’s recommended that the rules regarding drinking be set out in the next review of the Service user Guide. Not assessed at this fieldwork visit. The outcome of service users questionnaires about the standard of care provided in the home should be collated so that action can be taken in response to their input. 2. YA39YA39 Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Avenue The (3) DS0000016988.V343421.R01.S.doc Version 5.2 Page 35 - 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. 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