Inspection on 16/01/06 for Avenues (The) (Neave Crescent)

This inspection was carried out on 16th January 2006.

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

Avenues (The) (Neave Crescent) 24/04/07

Avenues (The) (Neave Crescent) 26/09/05

Avenues (The) (Neave Crescent) 16/02/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Avenues (The) (Neave Crescent) The Avenues 73a - 74b Neave Crescent Havering Romford Essex RM3 8HN Lead Inspector Julie Legg Announced Inspection 16th January 2006 02:00 Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 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 Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 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. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Avenues (The) (Neave Crescent) Address 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) The Avenues 73a - 74b Neave Crescent Havering Romford Essex RM3 8HN 01708 370048 The Avenues Trust Limited Miss Joanne Clifford Care Home 10 Category(ies) of Learning disability (10), Physical disability (10), registration, with number Sensory impairment (10) of places Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2005 Brief Description of the Service: 73a-74b Neave Crescent is a purpose built ten bedded unit comprising of two connected bungalows set on a housing development. The home is registered to provide care for residents with learning disabilities, physical disabilities and/or sensory impairment. All of the 10 bedrooms are ensuite with toilet and shower facilities. There are two large dining/sitting areas, two kitchens, two laundries, two assisted baths and two garden areas. The home also has its own custom built vehicle, which is used to take residents out. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took place over an afternoon and lasted four hours. During the course of the inspection the manager and one member of staff were asked about the service that is provided to the residents. Staff were observed interacting with residents and an inspection of the building, residents and staff files were examined, as were staff rotas. None of the residents are able to communicate verbally but all of the residents appeared to be relaxed and happy and enjoying the activities that they were undertaking. Written feedback was obtained from two advocates, and two health professionals who visit the home. This was the second statutory visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have been assessed. Three requirements and a recommendation was set at the previous inspection and the manager has complied with the required action. What the service does well: What has improved since the last inspection? The manager has ensured that all hand written entries on the Medication Administration Records (MAR) charts, whether new items prescribed or a change in medication, are signed and dated by the person making the entry and the name of the person who gave the instruction. New staff are currently Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 6 being recruited and bank staff are being used, which means permanent support workers are no longer working excessive hours. The manager has ensured that she is not rotered to provide hands on care on all her working days, which enables her to carry out her managerial duties. Residents’ likes and dislikes regarding their food and their dietary requirements are now clearly stated on the menus which are placed in the kitchen. This will ensure that all staff are aware of the residents’ dietary needs. The manager has ensured that the three requirements and the recommendation from the last inspection have been met within their timescales 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. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 and 4 were not tested on this visit. However evidence from the last inspection was that residents and relatives made informed choices about moving into the home, which were based on comprehensive assessments of need and full information about the proposed service. Residents and relatives were able to visit the home, prior to the resident’s admission. EVIDENCE: Standards 1,2,3 and 4 were not specifically tested on this visit, as there were no outstanding requirements in relation to these standards. At the time of the last inspection these standards were assessed as met. These standards will be re-tested at a future inspection. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Standards 6,9 and 10 were not tested on this visit. However evidence from the last inspection was that care plans reflect the needs and aspirations of the residents and provide the staff with the information they need to identify and meet resident’s personal, social and health care needs. The residents are as far as possible supported to take risks. Residents are assured that all information about them is handled appropriately. The residents, with assistance are able participate in all aspects of life in the home and to make decisions about their lives. EVIDENCE: Standards 6,9 and 10 were not specifically tested on this visit, as there were no outstanding requirements in relation to these standards. At the time of the last inspection these standards were assessed as met. These standards will be re-tested at a future inspection. The manager and staff have ensured that the residents are involved in all decisions about their lives. All of the residents have moderate to severe Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 10 learning difficulties and some residents also have a physical disability. Whilst their verbal communication is limited, they are able to communicate through picture cards, noises and behaviour. In one resident’s ‘a day in the life of’ (this is a description of each residents daily routines and preferences) it states that he will make a ‘bop’ sound when he is ready to get up and in what order he likes his personal care carried out. He doesn’t like the sound of a chair being scraped across the floor but he likes going out to loud and lively places. Another residents ‘a day in the life of’ states that when he sits up in bed, this means he is ready to get up. He likes a cup of tea and then a cup of coffee for breakfast and crunchy cereals. The staff observed that a resident likes the colour red and they are in the process of redecorating his bedroom in his favourite colour, another resident has assisted in decorating his bedroom. All of the residents are involved in bi-monthly meetings with their keyworkers, where their life plan is reviewed. Feedback from advocates, who visit the home was very complimentary, stating that the residents are very much involved with decisions regarding their lives. From the evidence gathered it is obvious that the manager and staff have put a lot of hard work into this aspect of the residents’ lives and a score of 4, commendable, has been given in recognition of this. All ten residents, no matter what level and complexity of disability are involved in the running of the home. They are involved in menu planning (using pictures), shopping trips, cooking, and redecoration of the home. They are also consulted on activities in the home and in the community. One of the residents is now able to put his laundry in the washing machine and the garden has been revamped to enable some of the residents to participate in weeding and watering of the plants. The care plans clearly indicate as to how each resident can indicate their choices. A score of 4 has also been given in recognition of the effort that staff have put in to, ensuring that the residents are involved in every aspect of life in the home. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15,16 and 17 Standards 13 and14 were not tested on this visit. However evidence from the last inspection was that staff support the residents to participate in social and leisure activities within the home and the community. Residents are able to take part in activities that are appropriate to their age and cultural, and also have appropriate relationships. Residents’ rights are respected and they are supported to take responsibility for their actions. Residents are offered and encouraged to eat a healthy diet. EVIDENCE: Standards 13 and 14 were not specifically tested on this visit, as there were no outstanding requirements in relation to these standards. At the time of the last Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 12 inspection these standards were assessed as met. These standards will be retested at a future inspection. Five care plans were examined which clearly indicate a varied activity programme that takes into account the resident’s interests and preferences. All of the residents are male but their activities are wide ranging. Many of them enjoy quite physical activities, which include, swimming, canoeing, rock climbing, horse riding, bowling and abseiling. Other activities include art therapy, foot massage, gardening, cooking, shopping at Lakeside and going to the pub. Staff keep a record of all activities and where a resident has not enjoyed an activity, this has been clearly documented. Feedback from an advocate stated that ‘the residents are offered many activities’. Nine of the residents have families who visit regularly. Feedback received from the relative’s annual questionnaire stated that ‘they are always made to feel very welcome when they visit’. The remaining resident did have an advocate, who unfortunately left, but the manager is in the process of engaging another. One of the resident’s sisters is in another home, the staff at Neave Crescent collect her and bring her to visit her brother. Since the summer holiday two of the residents have struck up a friendship and they now visit each other in their respective houses. Staff were observed interacting with the residents and the relationships appear to be warm and respectful, residents’ responses was of laughing and chuckling. A member of staff was seen to knock on a bedroom door before entering and then dealt with an embarrassing situation in a tactful and sensitive manner. A relative stated ‘that her son has never been treated so well, since moving to Neave Crescent’. The menu is set weekly taking into consideration the residents’ likes and dislikes, and also any dietary requirements, these are clearly stated in pictorial form as well as written in the residents’ care plans. A previous recommendation stated that this information needed to be written on the menus, which are placed in the kitchen. The inspector was able to examine the menus, which clearly identify each resident’s likes and dislikes and dietary requirements. This recommendation has now been met. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 13 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 and 20 Standard 19 was not tested on this visit. However evidence from the last inspection was that the residents’ physical, emotional and health needs are closely monitored and this ensures that their needs are recognised and met. Residents receive personal support in the way they prefer and require. Due to their level of disability, residents are unable to administer their own medication. There are policies and procedures in place to ensure that this is carried out safely. EVIDENCE: Standard 19 was not specifically tested on this visit, as there was no outstanding requirement in relation to this standard. At the time of the last inspection this standard was assessed as met. This standard will be re-tested at a future inspection. Care plans that were examined showed that residents are receiving personal support in the way in which they prefer. One resident prefers to have his teeth brushed and to be shaved before having his shower and likes to be dressed and undressed whilst laying on the bed. Another resident prefers to have his shower first and then he either sits or stands whilst his teeth are cleaned and Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 14 shaved. A relative stated ‘that her son was always well groomed and nicely dressed’. There are policies and procedures in place for the handling and administering of medication. Staff have received medication training during their induction training, and also have to complete a medication assessment questionnaire on their knowledge of storage of medication, homely remedies, off site administration and medication errors. Staff then have to shadow another member of staff for 2/3 days and then they are observed administering medication, before undertaking the task on their own. A requirement was set at the last inspection that all hand written entries on the Medication Administration Records (MAR) charts, whether new items prescribed or a change in a resident’s medication must be signed and dated by the person making the entry and who gave the instruction. The inspector examined the residents’ MAR charts and there was evidence that staff are signing and dating the change in medication and who gave the instruction. This requirement is now met. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 15 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): Standards 22 and 23 were not specifically tested on this visit. However evidence from the last inspection was that the manager and staff make every effort to deal with any problems or concerns and are able to understand how residents express their views and respond appropriately. Residents are protected from abuse by the policies, procedures and practices within the home. EVIDENCE: Standard 22 and 23 were not specifically tested on this visit, as there were no outstanding requirements in relation to these standards. At the time of the last inspection these standards were assessed as met. These standards will be retested at a future inspection. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 16 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): Standards 24,25,26,27, 28,29 and 30 were not specifically tested on this visit. However evidence from the last inspection was that residents live in a homely, comfortable and safe environment. Their bedrooms suit their needs and promote independence and the communal rooms and gardens complement and supplement residents’ individual rooms. The home is clean and hygienic and provides any specialist equipment that is required to maximise the resident’s independence. EVIDENCE: Standards 24,25,26,27,28,29 and 30 were not specifically tested on this visit, as there were no outstanding requirements in relation to these standards. At the time of the last inspection these standards were assessed as met. These standards will be re-tested at a future inspection. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 17 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): 33 Standards 34,35, and 36 were not specifically tested on this visit. However evidence from the last inspection was that the procedures for the recruitment of staff are robust and safeguards the residents who live in the home. Staff are appropriately trained and receive appropriate supervision and support to meet the needs of the residents. The residents are supported by staff who are competent and qualified. Staffing levels are satisfactory and there is sufficient staff on duty to meet the needs of the residents. EVIDENCE: Staff files show that all new staff undergo an induction course that is accredited to the Learning Disability Assessment Framework, which then becomes part of their NVQ2. The induction course covers all mandatory training, policies and procedures and they shadow another member of staff for a week. Eight members of staff are completing their NVQ”, one member of staff is completing her NVQ£ and another member of staff is undergoing her NVQ4, three members of staff have to complete their NVQ2. This demonstrates a positive commitment to training from both the provider and the manager. Other training that has been undertaken includes adult protection, understanding challenging behaviour, management of aggression, dealing with epilepsy, basic first aid, person centred planning, diversity in the workplace, sensory training, citizen advocacy and administration of medication. The Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 18 manager and staff have positive relationships with health professionals who visit the home. This was evidenced from the comments received from community nurses and occupational therapist. Duty rotas were inspected and they correlated with the staff on duty. There are normally six/seven staff on duty on each day shift and two waking night staff. All support staff carry out all cooking and domestic duties and there were sufficient staff on duty to meet the needs of the residents. The manager chooses to cover vacancies and sickness with her permanent staff team. At the last inspection the inspector was concerned at the excessive hours that some of the support workers were working and a requirement was set that the manager had to demonstrate that this practice was appropriate, safe and in the best interest of the residents. On inspection of the duty rotas, it was evident that staff are no longer working excessive hours. The manager has achieved this by using more bank staff and recruiting to permanent vacancies. This requirement is now met. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 19 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 and39 Standards 40 and 42 were not specifically tested on this visit. However evidence from the last inspection was that residents’ rights and best interests are safeguarded by the home’s policies and procedures. The resident’s health, safety and welfare is promoted and protected. Residents benefit from a well managed home and are confident that their views and opinions are taken into account regarding the development of the home. EVIDENCE: Standards 40 and 42 were not specifically tested on this visit, as there no outstanding requirements in relation to these standards. At the time of the last inspection these standards were assessed as met. These standards will be retested at a future inspection. The manager and senior support workers are experienced and qualified to run the home and they demonstrate a very clear understanding of the needs of the residents. A requirement set at the last inspection was that the manager Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 20 needed to ensure that she was not rotered to provide hands on care on all her working days, to enable her to carry out her managerial duties. The inspector examined duty rotas and there was evidence that the manager on some days was supernumerary to the support workers, therefore enabling her to carry out her managerial duties. This requirement is now met. The home undertakes an annual audit, which reflects the aims and outcomes for service users. Feedback is actively sought from residents (with support from independent advocates, where appropriate), this is achieved through evidence from life plans and reviews, as well as individual and group discussions. The views of relatives, friends and stakeholders are sought through annual questionnaires as to how the home is achieving its goals for the residents. The inspector examined some of the questionnaires that relatives had returned in September 2005, the comments were extremely favourable, one parent stated that ’This is the place we have dreamed about for the past forty years, to us it is like winning the lottery, it has set our minds at rest’. Another relative stated ‘I cannot fault the facilities or the staff who provide my son’s care. We are always given feedback on his health, his diet and trips out’. Similar positive comments had also been received from advocates and health professionals who visit residents at the home. Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x X Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 4 4 x X Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Avenues (The) (Neave Crescent) Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x x x DS0000060296.V272166.R01.S.doc Version 5.0 Page 22 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. Refer to Standard Good Practice Recommendations Avenues (The) (Neave Crescent) DS0000060296.V272166.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. 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