Inspection on 24/04/07 for Avenues (The) (Neave Crescent)

This inspection was carried out on 24th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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) 16/01/06

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 Unannounced Inspection 24 April-1st May 2007 10:00 th Avenues (The) (Neave Crescent) DS0000060296.V337355.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 Avenues (The) (Neave Crescent) DS0000060296.V337355.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. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 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 01708 370048 neave.crescent@theavenuestrust.co.uk 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.V337355.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: 73a-74b Neave Crescent is a purpose built ten- bedded unit comprising of two connecting bungalows set on a housing development. The home is registered to provide care for residents with learning disabilities, physical disabilities and/or sensory impairment. The home is on a bus route and is within a short distance of shops, Romford market and other local community resources. The home also has its own custom built vehicle, which is used to take service users out. All of the 10 large bedrooms are en-suite with toilet and shower facilities. There are two large dining/sitting areas; two kitchens, two laundries, two assisted baths and two garden areas, and all areas are wheelchair accessible. The home’s Statement of Purpose is made available to service users on request and a copy is kept in the staff office. Every service user/relative has been given a copy of the home’s Service User Guide. The fees for the home are £1449.80 a week, this does not include hairdressing, toiletries, private chiropody or holiday spending money. This information was given by Joanne Clifford (the manager) on 24th April 2007 Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days. A second visit was required to allow the inspector access to staff files. The manager was available throughout the inspection. Discussions took place with the manager and four support workers; two of them were seniors. Staff were asked about the care practices that service users received and what it was like to work at Neave Crescent. The inspector was unable to discuss with service users their views on living at the home (due to non verbal communication), however observing the service users and speaking to relatives and an advocate informed the inspector that the service users at Neave Crescent receive an excellent service that meets their needs. A tour of the home was undertaken, including all of the bedrooms, bathrooms, toilets, kitchens and living areas. The home was clean with no offensive odours. Service users’ files were examined along with staff files and other records. These records included Health & Safety documentation, administration of medication, staff rotas, complaints book and finance records. Information was also gathered from the pre-inspection questionnaire that was completed by the manager. The inspector had a discussion with the manager and staff about how they thought the people living at the home wished to be referred to in the report. The manager and staff always refer to the people as service users; therefore this will be reflected accordingly throughout this report. The inspector would like to thank the service users, manager and staff for their input during this inspection. What the service does well: The home has a very experienced manager and a dedicated staff team that are committed to the service users and the quality of care they receive. They work in partnership with health professionals to ensure that the service users’ health is at an optimum; this ensures that service users retain and in some cases improve their independence. All of the service users require a high level of support with their personal care needs and this is carried out in a way that promotes their independence and choice. It was evident that the home is run in the best interests of the service users. Every effort is made to ensure that their views and of significent others are taken into account on any issues relating to the running of the home. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 6 There is an underlying attitude of the manager and the staff that almost any thing is possible and this has had a positive effect on the lives of the service users at Neave Crescent. Their lives have been enriched by this attitude, as they have experienced activities within the home and the wider community that relatives did not think were possible. Life within the home has also had a positive effect on their psychological well -being (relatives stating that the service users are more aware, more responsive towards them and now enjoy being hugged). What has improved since the last inspection? 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. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2 and 3 People who the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective service users and their relatives have the information they need to be able to make an informed choice about moving into the home. The assessment of needs and other information received from health and social care professionals means that staff have detailed information to enable them to determine whether or not they can meet the needs of prospective service users. Prospective service users know that the home can meet their needs. EVIDENCE: The Statement of Purpose and the Service User Guide are both in pictorial format, which enables prospective service users to know what the home is like and what services they can offer. The Statement of Purpose has recently been reviewed and updated. The current service users have been living at the home for some considerable time; all of them since the home opened in 2004. It would be the procedure of the home to ensure that any new service users are appropriately assessed prior to admission. The funding authority and health professionals would Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 9 provide assessments as well as the home carrying out their own assessment. Further information will also be gathered from the prospective service user and their families if appropriate. The admission process would be designed around the needs of the prospective service user. The prospective service user may make several visits to the home and possibly an overnight stay to ensure that they like the home and to meet the other service users. This transition period would also allows staff to get to know the prospective service user and to know whether they can meet the their needs. One relative told the inspector “I couldn’t believe it when I came to look around the home, the staff were so helpful and put my mind at rest”. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. All of the service users’ identified needs are reflected in up to date care plans and risk assessments. This ensures that service users’ needs are being appropriately met and that service users and others are safeguarded. The service users, with assistance, are able to participate in all aspects of life in the home and to make decisions about their lives. EVIDENCE: The manager and staff have ensured that the service users are involved in all decisions about their lives. There is a care planning system in place that is clear and concise. Each service user has an individual person centred care plan and this information is also provided in pictorial format. These care plans were completed with the involvement of the service user and their relatives (if Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 11 appropriate). These very comprehensive documents cover areas of the service users’ lives, such as, ‘how I eat’,’ how I communicate’, ‘my medication’, ‘my mobility’, ‘how I sleep,’ ‘likes and dislikes’, ‘things that are important to me’, ‘what I need help with’. One service user likes to sleep on his right side with a V shaped pillow between his legs, he prefers a shower and doesn’t mind being shaved but he doesn’t like mouth care as it makes him gag. Another service user does not like being on his own and will shout to get attention and he likes to be massaged and also enjoys bubble baths and music sessions. Whilst verbal communication is limited, the staff have spent some considerable time in learning about the different ways the service users communicate either through noises, body language and facial expressions. One service user will shout when he is ready to get up in the morning, another service user makes a quacking sound when he wants attention and brushes his hand over his face when he is bored or not interested. A score of 4 has been given in the work that has been undertaken in ensuring that the care plans and the person centred plan are so meaningful for every service user. All of the service users are involved in regular meetings with their keyworkers, where their life care plan is reviewed. Relatives and advocates are also involved with the service users and assist them in decision- making within the home, such as, the recent redecoration programme of their bedrooms. Each service user has an individual daily log sheet, which is in written and pictorial format. These daily records reflect the assistance that has been given on a day-to-day basis and how service users are involved in the life of the home, such as, ‘activities I have undertaken’, ‘daily living skills I have been involved with’, ‘how I am and any concerns or health issues’. They are involved in menu planning (using pictures), shopping trips, cooking, gardening and as stated above the redecoration of their bedrooms. They are also consulted on activities in the home and in the community. The service users all with assistance are able to take part in varying degrees with daily life activities within the home, one service user helped to prepare a salad (with the support worker doing hand over hand), another service user helped to take the rubbish out to the dustbin, other service users have helped to water the garden and to put the laundry in the washing machine. All of the service users have a moderate to severe learning disability and physical disabilities, with the majority of service users being wheelchair dependant. Other records seen, showed service users’ choice of meals, whether or not they participated in activities within the home and community. A score of 4 has been given in recognition of the manager and staff ensuring that the service users are involved in every aspect of life in the home. Staff were observed interacting with the service users, their relationship was easy going and friendly but in a professional manner. Staff were seen to ask service users what they wanted and offered them different objects, signs and pictures to assist the service user to be able to indicate what they wanted. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 12 Staff also advised service users of what they were going to do such as, “I’m taking you to the bathroom, is that ok?” and the appropriate assistance was given. Service users are encouraged to take reasonable risks and there were detailed risk assessments that had been regularly reviewed. Assessments showed areas identified such as, tasks and activities within the home and in the community, health risks and medication and what action to be taken. These risk assessments have been forwarded to the service user’s care plans. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,14,15,16 and 17 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users are able to take part in leisure activities and other activities within the local community that are appropriate to age and culture. Service users have appropriate personal and family relationships. Their rights are respected and are supported to take responsibility for their actions. Service users are offered and encouraged to eat a healthy diet. EVIDENCE: Service users’ care plans identify lifestyle choice, such as local leisure activities, activities within the home and family contact. The service users have ample opportunities for personal development and service users’ leisure activities are individualised and varied. Nine of the service users have been on an ‘outward bounds’ holiday were they took part in canoeing, horse riding and Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 14 abseiling. Two service users have recently been to Centre Parcs, two others are going to the Isle of Wight and six are going to Blackpool for a ‘seventies’ weekend. Monthly boat trips are undertaken down the river Stort and during the month of April day trips have taken place to a Butterfly farm, Canary Wharf, Southend-on-Sea, Clacton, pub lunch and a garden centre for afternoon tea. Some of the service users go shopping to buy their toiletries and clothes and others enjoy bowling, cinema, visiting the local park, music therapy sessions and horse riding. The manager is currently in discussions with a local private hospital to use their hydrotherapy pool, which will allow the service users to go swimming. One of the service users is joining Avenues football team (known as Avenues Albion) and some of the other service users are going to watch. Those service users that enjoy watching football go to the local pub (some in their England shirts) to watch the match on a big screen. Activities within the home include music sessions (one of the support workers plays the guitar and the home have purchased a drum kit, which some of the service users like to use), hand and foot massage, painting and accessing the sensory room. The garden has raised flowerbeds, which means service users can help with the gardening and there is also a large trampoline, which many enjoy. The manager has arranged for ‘Zoolab’ to visit the home on 2nd May, this is an organisation that brings animals to the home (spiders, guinea pigs, rabbits, snakes, tortoises and hamsters) for the service users to see and touch. A relative stated, “It’s lovely he is always out and about, where he was before he hadn’t even been to the shops”, another relative stated, “We now phone the home before we visit to make sure he is there, as he is always out”. A score of 4 has been given in recognition of the work that the manager and staff have undertaken in enabling the service users to participate in such varied activities, this allows them to have ample opportunities for their personal development. The majority of the service users receive visits from their families, some more regularly than others. One of the service users has a sister in another home and the staff at Neave Crescent facilitate the visits between them, another service user has just been found by his nephew (he had been looking for him for the past three years) and he visits regularly with his children and dog, which most of the service users enjoy. One of the relatives assists with the gardening and another bakes cakes. One of the service users has an advocate who visits him monthly. She stated, “The home is the tops, there is such a lovely atmosphere, I really look forward to my visits. I have made a couple of small suggestions to Jo (the manager) and she has acted upon them straight away. I was invited to their Christmas meal at the Moby Dick and when D went to Centre Parcs, the staff sent me a postcard on his behalf”. There are no restrictions on visiting times to the home. One relative stated, “I look forward to coming, I feel we are one big family”, another stated, “It’s a real pleasure coming, everyone is so friendly and nothing is too much trouble”. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 15 There are no set ‘house’ rules and service users were observed to go about the home freely. At the time of the inspection one service user was still in bed and another was having a shower. Staff have the overall responsibility for the cleaning of the home, however some of the service users are able to participate at varying levels, such as, dusting their bedrooms, putting their clothes away, helping with putting their laundry in the washing machine and putting the rubbish out. The menu is set weekly taking into consideration the residents’ likes and dislikes, and also any dietary requirements, such as a pureed diet. These requirements are clearly stated in pictorial form as well as written in the residents’ care plans and on the menu board that is placed in the kitchen. On the day of the inspection, the meal was freshly cooked chicken, salad and jacket potatoes with fruit and yoghurt for dessert. Four of the service users are now able to feed themselves and two others are able to manage finger food. Those service users that require assistance with eating their food, received assistance from staff, who carried out this task sensitively; not hurrying them, chatting and offering the service user a drink. Menus that were looked at showed that different meals were cooked depending on service users’ likes and dislikes. One service user is Afro-Caribbean but chooses to eat a predominantly English diet. The home’s staff group are culturally diverse with staff from Nigeria, St Lucia, Mauritius, Ghana and Ireland and the home has themed evenings where staff cook meals that are representative of their culture. Food store cupboards, the refrigerator and freezer were inspected and all foods were appropriately stored. The food in the refrigerator corresponded with the meals planned for the day; there was also fruit, cakes, biscuits and crisps, if service users wanted a snack. A relative stated, “I visit the home on Wednesday and Sunday and give my son his dinner, the food is lovely and they nearly always have a roast dinner on a Sunday”. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 16 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): Standards 18,19,20 and 21 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users receive personal support in the way they prefer and their physical and emotional needs are met. Service users’ wishes regarding their death are clearly recorded; this should ensure that their final wishes are carried out. None of the service users are able to administer their own medication. There are policies and procedures in place to ensure that this is carried out safely. EVIDENCE: Care plans and daily records were examined and discussed with the manager. The care plans clearly identify health and personal care needs and how these needs should be met. All of the service users require assistance with their personal care, though they are encouraged to hold the flannel, wipe their face and to brush their teeth. One service user’s keyworker has the same cultural background and this ensures that the service user’s personal care needs are Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 17 met appropriately. A member of staff was observed asking a service user if he would like to go to the toilet, this was carried out in a very discreet way, which did not appear to cause him any embarrassment or distress. Some service users prefer to bath and others prefer to shower, some prefer this in the morning and others in the evening. Staff had very clear views on each service user’s style of dress and their preferences. Service users were seen to be dressed in clothes that were appropriate for the time of year and which suited their personalities; one service user was wearing trainers, shorts and t-shirt, another service user was wearing jogging bottoms and t-shirt and another was wearing trousers and a shirt. A relative stated, “He is always dressed nicely and always looks lovely and clean”. A score of 4 has been given in recognition of the staff ensuring that service users receive support with their personal care needs in the way they prefer and require. Records inspected showed that service users have very comprehensive personal health records and health action plans; all of have been reviewed within the past six months. All service users are supported to access dental care, opticians, chiropody, and the community nurse and psychiatric out patient appointments. The dentist wrote to the manager and complimented the staff on the mouth care of the service users and the community psychiatrist has reduced his visits from six monthly to a year because of the improvement in the service users’ health (one service user used to experience 20/30 seizures a day this has decreased to 2/3 a week). On moving into Neave Crescent only one service user was able to walk independently. Care staff have been working closely with the Community Physiotherapist and Occupational Therapist and the improvement in their mobility has greatly improved; one service user is now walking independently, two are walking with two members of staff, another service user is walking in the hoist and hopefully will be looking to walk with a frame. The staff have also worked with the service users in improving their continence; two of the service users are now using the toilet at night and another service user will take staff by the hand when he wants his bowels opened. Some of the families felt that their relatives showed signs of an improvement in their emotional well-being and awareness of their surroundings. One family member stated, “Where he lived before he hardly smiled, now he hugs us all the time”. Another relative stated, “He seems to understand a little bit more and takes more notice of what is going on, he looks so well”. A score of 4 has been given in recognition of the work undertaken by the manager and staff in improving the physical health of the service users and ensuring their emotional needs are met. There are policies and procedures for the handling and recording of medication within the home. Staff have received medication training and there is a list of staff (with their signatures) that are competent in the administration of medication. Staff have also received training in the administration of rectal Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 18 diazepam. Medication Administration Records (MAR) charts and the medication cupboard were checked and found to be correct. Three of the service users’ medication was audited and the amount given and the amount remaining reconciled with the MAR charts. The manager regularly undertakes medication audits to ensure that staff are administering medication appropriately. A close relative of one of the service users recently passed away, the staff explained to him what had happened and accompanied him to the funeral and later they planted a rose bush in the garden in memory of the relative. Every service user has a document ‘When I die’, this has details of people’s preferred wishes regarding their funeral arrangements; this document has been completed with the assistance of families and advocates. The document is in written and pictorial format and has details where and how they want their funeral to take place, whether they want flowers or donations to a charity and what music/readings they would like. It is a difficult subject for staff to talk to service users and relatives about, however this appears to have been dealt with in a sensitive manner. It would be a recommendation that staff now discuss with service users and relatives (if appropriate) Preferred Place of Care Plan (PPC). PPC would detail the resident’s thoughts about their care and the choices they would like to make, including saying where they would want to be when they die. Information about the family can also be recorded so that care staff can read about who’s who and what matters to them. Details of the ‘end of life’ programme manager where left with the manager. This is Recommendation 1. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 19 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): Standards 22 and 23 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The service users’ views are listened to and acted upon. Service users are protected by the policies and procedures and the monitoring systems within the home. EVIDENCE: The home has a clear complaints procedure, which is available in large print and pictorial format. A copy of the procedure has been made available to all of the service users and to their relatives and advocate. The complaints procedure is also displayed in every service users’ bedroom. Since the last inspection there has been one anonymous complaint, which involved two members of staff but did not impact on service users and was not the basis of a safeguarding adults investigation. This complaint was thoroughly investigated and as a result two members of staff were disciplined. This complaint had been investigated by the organisation and it was thoroughly discussed with the manager during the inspection process. The inspector is confident that systems and procedures have been reviewed to ensure that a similar occurrence would not happen again. The manager welcomes complaints and suggestions about the service. In discussions with relatives and the advocate, it was obvious that they were aware of the complaints procedure and would have no hesitation in making a complaint if necessary. All of the relatives that were spoken to stated that they Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 20 were extremely happy with the service and felt that “The staff are doing a first class job”. One relative stated, “ I would have no hesitation in going to Jo (the Manager) if I had a problem”. Another stated, “If I had any concerns, I know that Jo would deal with it straight away”. The advocate told the inspector, “I suggested that one of the service users might benefit from taking linseed oil, and Jo thought this was a good idea and went out and bought some”. All of the service users’ communication is conveyed through gestures and noises. In the care plans, the section on ‘How I Communicate’ clearly details how each service user indicates their need, likes and dislikes. This will assist the staff in ensuring that service users are happy with the care being provided. Staff that were spoken to were clear in that each service user had their own way of communicating, they all spoke about getting to know the service user really well and giving them time to convey how they are feeling and what they wanted. During the inspection all of the service users appeared to be calm, relaxed, smiling and laughing, nobody appeared distressed or agitated. An advocate regularly visits the home and there are regular service users’ and relatives meetings where suggestions, concerns and complaints can be discussed. Service users are encouraged to participate in decision-making on issues and events within the home; colour schemes for the bedrooms were decided on through staff knowledge of service users likes and dislikes (one likes the colour red, another likes bright colours and another likes footballs), and if service users indicate that they enjoyed an activity, then they are organised again, likewise, if any activity was not enjoyed, such as, one of the service users was taken horse riding, which he did not enjoy and he was therefore found an alternative activity. The home has policies and procedures for the safekeeping and expenditure of service users’ money. The finance department of the organisation monitors service users’ money, which is held in safekeeping by the home. The responsible individual when carrying out the Regulation 26 visits will also monitor service users’ finances. None of the service users are able to maintain their own benefit book or handle their own financial affairs. Seven of the service users are under Court of Protection and a local solicitor is the receiver. Service users are given support to make purchases, receipts are kept for all expenditures and records of money held. Three service users’ accounts were inspected and all were in order. The home has a comprehensive ‘safeguarding adults’ policies and procedures; these include the local authority (London Borough of Havering) policy and procedure, DOH document ‘No Secrets’ and the organisations’ policy and procedure. There was signed evidence that these have been read by all of the staff. The manager was clear in that incidents needed to be referred to the Local Authority as part of the local safeguarding procedures. Four staff members that were spoken to were very clear on what constituted abuse and their responsibility in reporting any potential or actual abuse. One member of Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 21 staff gave an example of an abusive situation that they witnessed in a previous home that they had worked in and how they had reported the member of staff to the manager. Staff files indicated that all members of staff have attended ‘safeguarding adults’ training and this subject has also been dealt with through individual supervision sessions and staff meetings. Staff training has also taken place in self -injurious behaviour, understanding challenging behaviour and management of aggression. This training shows them how to respond appropriately to physical and verbal aggression and they fully understand that the use of physical intervention is a last resort and know what other alternatives to use. The manager and records confirmed that no service user has been physically restrained. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 22 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): Standards 24,25,26,27,28, 29 and 30 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is very homely, comfortable and provides service users with a safe environment. The bedrooms suit service users’ needs and promotes their independence. The communal rooms and gardens complement and supplement service users’ individual rooms. The home is clean and hygienic and provides any specialist equipment that is required to maximise the service user’s independence. EVIDENCE: The home opened in August 2004 and has its own purpose built minibus (the majority of the service users are not able to access public transport), which allows the service users access to community facilities and services. The home is also purpose built and consists of two, five-bedroom bungalows, each with their own large open plan kitchen/diner and lounge. All of the bedrooms are of a generous size, each with their own en-suite toilet and walk-in shower, some Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 23 have specialist beds and overhead electric tracking for hoists. All of the bedrooms have recently been redecorated in very individual colour schemes, one of the service users likes the colour red and this has been introduced on the walls and the soft furnishings, another service user likes football and he has a rug and bed linen with footballs and another service user likes bright colours and his walls have been painted yellow. Service users’ interests and hobbies were also apparent, one service has posters of Bart Simpson on his bedroom wall, all of the service users have CD players mounted on their bedroom walls and sensory equipment such as rotating lights were also evident. Photographs of families were also displayed on bedroom walls and bedside cabinets. A score of 4 has been given in recognition of the service users’ bedrooms promoting their independence and meeting their need and lifestyles. In each of the bungalows there is a laundry room, an assisted bathroom (for those service users, who prefer to bath) and toilets that are situated near the lounge. The open plan kitchen/dining area and lounge are spacious and allow the service users, particularly those that are wheelchair dependant to access all areas and to participate in activities in the kitchen. These rooms have also been redecorated and have been made homely with pictures and ornaments and vases. The home also has a sensory room, which is used by the majority of the service users. The garden is well maintained and is accessible to all of the service users. There are raised flowerbeds, which enables the service users to help with the planting and watering of the plants or there is sufficient space to just and watch. There is also a large trampoline in the garden, which some of the service users enjoy. The home was very clean and tidy and free from any unpleasant odours. The home is well maintained and there was evidence that all repairs are dealt with promptly. The home has a robust infection control policy and would seek advise from external specialist if and when required. The manager and staff have made a great effort to ensure that the home does indeed feel like home. A score of 4 has been given in recognition of the work carried out by the manager and staff in ensuring that the physical environment of the home provides a homely, comfortable and safe environment for all the service users. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 24 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): Standards 32,33,34,35 and 36 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users are supported by qualified and competent staff Staffing levels are satisfactory and there are sufficient staff on duty, who have the appropriate skills and training. This ensures that staff are able to meet the individual needs of the service users. The procedures for the recruitment of staff are robust and provide safeguards for service users living in the home. Staff receive regular supervision and annual appraisals, which is beneficial to the service users. EVIDENCE: Duty rotas were inspected and they correlated with the staff on duty, there were sufficient staff on duty to meet the needs of the service users. There are 6/7 staff on duty on each shift, depending on the activities for that day and three night staff (two are waking and one sleeping). The manager at times is part of the shift and at others she is supernumerary, this allows her to carry Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 25 put her managerial tasks. Staff retention is very good and there has only been one member of staff leave since the last inspection. The manager uses ‘bank’ staff to cover any vacancies; these staff are mainly permanent members of staff and are therefore familiar faces to the service users. The manager advised the inspector that the organisation has looked at the staffing structures of their homes and are introducing deputy managers. This post will be to support the managers and the senior support workers; interviews are to take place in May. There is a clear recruitment policy and procedures. Staff files are kept at the organisations’ head office. The inspector requested staff files of the most recent employees and these were bought to the home to be examined. These files showed robust recruitment procedures had taken place; a completed application form, two written references, health screening questionnaire, copies of qualifications, driving licence, bank details and a current Criminal Records Bureau (CRB) check. Staff that were spoken to confirmed that they had a face-to-face interview and that references and checks had been carried out prior to them commencing work at the home. There was also evidence on files that all new members of staff undertake an induction programme and are subject to a satisfactory probation period. One of the new members of staff confirmed that he had recently had a probationary meeting with the manager and had been advised that he had successfully passed his probation period and he had also received written confirmation. Equality and Diversity is monitored through the selection and recruitment procedure. The staff are from diverse cultures and backgrounds, which are different from the majority of the people living in the home. However, all staff have undertaken training in ‘Valuing Diversity’ and this ensures that the cultural, spiritual and other diverse needs of the service users are understood and met. There was evidence on staff files that an induction programme had been undertaken as well as Food & Hygiene, Health & Safety, COSSH, Safeguarding Adults, first aid, moving & handling, infection control, administration of medication, person centred planning, autism awareness, sensory training and valuing diversity. Fourteen of the staff have either NVQ 2 or 3; the remaining three staff are currently undertaking their NVQ 2. All of the staff hold a current first aid certificate. One of the senior support workers is currently training to become a Person Centred Planning facilitator; which means she will train other staff in completing Person Centred Plans. Every staff member has a training profile where training that has been undertaken is recorded and future training needs are identified. Staff files indicate that they are receiving monthly supervision (this exceeds National Minimum Standards, which states ‘at least six times a year’). The senior support workers are supervising some of the support workers and it is a recommendation that they should attend a supervisory course. This is Recommendation 2. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 26 There was written evidence that staff have received annual appraisals and that regular staff meetings are well attended and held regularly. Staff that were spoken to confirmed that supervision and staff meetings were taking place and that supervision was seen as a high priority. All spoke highly of Jo and comments were “she is the best manager I have ever had, she is there for us and the service users”, another stated, “It’s really good having supervision, it helps me to look at what I am doing and any training that I need. I was really apprehensive about doing my NVQ 2 but Jo and the others were really supportive. I’m really proud of myself”. Relatives that were spoken to were very complimentary of the staff stating, “They are a brilliant, dedicated team, and nothing is too much trouble”. A committee member of the organisation visited Neave Crescent last year and written comments, ‘all staff are very friendly, approachable and helpful. A very impressive service’. A score of 4 has been given in recognition of service users being supported by a very competent, effective and qualified staff team. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38,39 and 42 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is managed by a qualified and experienced manager who also has very sound management practices, this means service users’ health, safety and welfare are promoted and protected. Service users can be confident that their views underpin the self-monitoring, review and development of the home. EVIDENCE: The manager has been in post since the home opened in 2004. She is committed to providing and improving the quality of care at Neave Crescent to achieve this she works closely with health professionals, advocacy service and the Commission. She has completed numerous courses; stress management, Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 28 supervision, counselling in the workplace, managing diversity and advanced financial management, she has her NVQ 4 in care and management and is an NVQ assessor. She is currently undertaking training to become a Person Centred Active Support trainer and the organisation has put her name forward to commence her Diploma in Management Studies in June 2007. She has sound knowledge of both strategic and financial planning and how the operational plan for the home fits in with these. She has responsibility for the financial budget of the home and is aware of her budgetary limitations. In previous discussions with the service manger and discussions with the registered manager it is clear that the home has effective and regular support from the organisation and there are clear lines of accountability. A score of 4 has been given in recognition of the manager’s leadership and the benefit that the service users receive in living in a home that is well run and in their best interests. Discussions with the manager showed she was able to describe a clear vision of the home based on the organisation values. It was evident that she was able to communicate a clear sense of direction and demonstrated a sound understanding and application of good practices particularly in relation to continuous improvement of the service. The manager carries out spot checks out of ‘normal hours’ and this is supported by monthly supervision of all staff and other quality monitoring systems, such as, service users’ meetings and feedback from advocates. A review of the home has also been undertaken with information being gathered from service users, health professionals, advocates and relatives. A health professional’s written comments stated ‘Jo and the staff are very welcoming, friendly and always on hand to help. They meet all the patients’ needs.’ A relative had written ‘Jo is very obliging, nothing is too much trouble, I know she has his best interests at heart”. An annual development plan will be completed reflecting the comments and views from the surveys. Regulation 26 visits are undertaken regularly by the responsible individual to monitor and report on the quality of the service. A copy of this report is sent to the Commission. During the course of the inspection the manager was observed leading from the front, by directly engaging with service users and the staff. There was a high level of praise from relatives, staff and other professionals who visit the home and it was evident from her interaction with the service users that they enjoyed her company. One relative stated, “Jo is lovely, she runs a first class service”. An advocate stated, “Jo is brilliant”. A member of staff stated, “She goes that extra mile for all of us”. All of the staff spoke very highly of the manager and how well they felt supported by her. There was evidence that staff receive monthly supervision, annual appraisals, regular staff meetings and direct observation of their care practices. The manager was also able to demonstrate her knowledge and commitment to equality and diversity issued which are given priority in caring for the service Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 29 users. It was evident that the manager followed the policies and procedures of the home and those of the organisation. As previously stated record keeping remains of a consistently high standard with records being kept securely in accordance with the Data Protection Act. All the working practices in the home are safe, within a risk management system. The manager proactively monitors the homes Health & Safety performance and consults other experts and specialist agencies when necessary. Risk assessments were in place for fire, first aid, infection control and moving and handling. Staff have the benefit of a structured induction in line with the Learning Skills for Council, which covers infection control, basic first aid, fire training, moving and handling and food & hygiene. Fridge and freezer temperatures are taken and recorded daily and food that was stored in the fridge and freezer was covered and dated. Fire drills are taking place regularly; Fire extinguishers received their annual check in March 2007,the fire risk assessment was completed in November 2006 and reviewed in January 2007 and the last fire alarm service and emergency lighting test was undertaken in March 2007. The annual Gas safety certificate is dated July 2006; the five-year Electrical safety certificate is dated July2004 and the Legionella test for the home was carried out January 2007. An external Health & Safety audit is to be undertaken on 18th May 2007. At the time of the inspection there were no issues relating to Health & Safety, which means that service user’s safety is assured at Neave Crescent. Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 30 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 X 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 4 25 4 26 4 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 4 4 4 X X 3 X Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 31 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 YA21 Good Practice Recommendations It is recommended that ‘End of Life’ care plans be developed for all service users. This should include information about the individual’s wishes, choices and decisions. It is recommended that senior support workers attend a supervisor’s course. This will enhance the supervision of the support workers. 2 YA36 Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Avenues (The) (Neave Crescent) DS0000060296.V337355.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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