Inspection on 26/09/05 for Avenues (The) (Neave Crescent)

This inspection was carried out on 26th September 2005.

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

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

Other inspections for this house

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

Avenues (The) (Neave Crescent) 16/01/06

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 The Avenues (Neave Crescent) The Avenues 73a - 74b Neave Crescent Romford Essex RM3 8HN Lead Inspector Julie Legg Unannounced Inspection 26 September 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Avenues (Neave Crescent) Address The Avenues, 73a-74b Neave Crescent, Romford, Essex RM3 8HN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01708 370048 The Avenues Trust Ltd Miss Joanne Clifford CRH Care Home 10 Category(ies) of LD Learning disability (10) registration, with number PD Physical disability (10) of places SI Sensory Impairment (10) The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 16 February 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. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over four hours in the morning. Staff were observed interacting with the residents and discussion took place with the senior support worker, as the registered manager was on annual leave. A tour of the home was undertaken and a number of residents and staff files were inspected, as were other records. Feedback was given to the senior support worker at the end of the inspection. What the service does well: What has improved since the last inspection? Most of the staff have been working together for over a year with the residents, which has enabled the staff to have a greater understanding of their needs. Each staff file kept at the home now contains a complete Criminal Records Bureau check and an up to date photograph. The home is undertaking regular checks on the hot water to ensure that the temperature is being regulated safely. All fire drills contain specific information about the conduct of the drill and are not combined with the weekly fire point tests. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3& 4 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 their admission. EVIDENCE: Neave Crescent was purpose built to meet the needs of patients from a long stay hospital. There was evidence that the registered manager and staff had spent a considerable amount of time introducing the residents to their new home. Residents undertook frequent visits to the home during the building and completion and residents and relatives views were sought during this period on room décor and other issues appertaining to the resident’s care. Staff from Neave Crescent also spent time with the residents prior to their discharge from their long stay hospital. An advocate was also involved with the residents for a considerable amount of time prior to their discharge and on their admission to the home, this ensured that theirs and the relatives wishes and aspirations were listened to. The placing authority and health professionals carried out comprehensive assessments, which enabled the home to develop individual care plans. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 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 standard(s) 6,7,9&10 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 as far as possible, participate in the life of the home and are supported to take risks. EVIDENCE: Care plans were examined and compared with the support being provided. Staff were observed interacting with residents and some areas of care were discussed with the senior support worker. The residents have previously spent the vast majority of their lives in a long stay hospital. The care plans and risk assessments clearly recognise that the residents need to experience ordinary living within a safe environment. They also take into account the range of learning and physical disabilities that the residents have. To further enhance the care plans each resident has a ‘my plan’, which includes people in my life, what matters to me, my dreams and a communication profile. Whilst verbal communication is limited, the residents are able to communicate through picture cards, noises and behaviour, this is also clearly documented in their care plans. The registered manager and the staff are to be commended for the work that has gone into ensuring that the care plans and the person centred plan is meaningful for each of the residents. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 10 Detailed risk assessments on activities such as gardening, cooking, swimming, shopping and numerous others were available that evidenced residents were being supported to experience ordinary living within a safe environment The residents’ care plans and risk assessments are updated regularly to identify any change in need. Many of the residents have complex health needs and there is documentation that evidences health professionals input and advice that has been given has been acted upon. For residents who have behaviour that challenges, there are details of their different behaviours and guidelines on how to deal with the situation to ensure the resident’s safety. Confidential information regarding residents is locked in a filing cabinet and only shared on a need to know basis. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 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 standard(s) 13,14&17 Staff support residents to participate in social and leisure activities within the home and the community in which they live. Residents are offered and encouraged to eat a healthy diet. EVIDENCE: Each resident has a varied activity programme which takes into account the resident’s preferences, interests and experiences. Residents do not attend specialist day services but participate in leisure activities within the home and the community including music therapy, shopping, discos and visits to Southend, Hainault Park and Cadbury World. Within the home, residents have access to a sensory room and participate in gardening, cooking and playing games. Five of the residents are going to Norfolk for a holiday and four of the other residents are going to the Lake District on an ‘Outward Bounds Course’. One of the residents has recently celebrated his 60th birthday and as he enjoys water, the staff took him and a friend on an overnight stay on a boat and dinner at a country pub. He also enjoyed a party with the other residents and his family. Another resident enjoys football and he has an array of soft footballs in his bedroom to kick around. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 12 The menu is set weekly taking into consideration the resident’s likes and dislikes. In the residents’ care plans, food likes and dislikes are in pictorial form. One resident does not like rice or pasta but he likes curry, he is given a jacket potato instead. Another resident requires thickened drinks and his food needs to be blended, this is clearly documented in his care plan and his ‘about me’ book. To ensure that these instructions are adhered to at all times, this information and resident’s likes and dislikes needs to be written on the menus which are placed in the kitchen. Food store cupboards, the refrigerator and freezer were inspected and all foods were appropriately stored. The home is recording refrigerator and freezer temperatures twice daily. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 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 standard(s) 19 &20 The residents’ physical and emotional health needs are closely monitored and this ensures that their needs are recognised and met. Due to their level of disability, residents are unable to administer their own medication, this is always carried out by staff. There are policies and procedures in place to ensure that this is carried out safely, but some changes are needed to the recording on the Medication Administration Records to ensure residents’ safety. EVIDENCE: Records inspected, showed that residents are being referred to specialist health professionals such as physiotherapist, occupational therapist, speech and language therapist and specialist nurse. One resident has recently acquired specialist boots to assist him with standing and walking. The staff are working closely with the therapist in ensuring he wears his boots everyday. Routine health screening from chiropodists, dentists and doctors have also been undertaken. One of the residents has experienced a number of falls. This has been clearly documented and advice has been sought from his GP, who has referred the resident to a neurologist to review his medication for epilepsy. There are policies and procedures for the handling and recording of medication within the home. 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 The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 14 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. Residents’ medication was checked against the Medication Administration Records (MAR) charts and these were correct. But the manager must ensure that all handwritten entries on the MAR charts, whether new items prescribed or a change in medication, must be signed and dated by the person making the entry and who gave the instruction. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 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 standard(s) 22&23 The registered 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: The complaints procedure is available in written and picture format, both versions include details of who to contact at the Commission. There has not been any complaints since the last inspection but the inspector is satisfied from discussion with the senior support worker that should any complaints arise they would be dealt with promptly. Despite limited verbal communication the residents are able to make their views known by sound or behaviour. The records demonstrated that staff take careful note of behaviour and sounds and what it might mean and make changes. Many of the residents receive regular visits from relatives, advocates and health professionals, who would take any concern to the attention of the registered manager or a member of staff. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. Staff files indicated that all of the staff have received training in Adult Protection/Abuse Awareness as part of their induction training. Those staff spoken to were aware of the action to be taken if there were concerns about the welfare and safety of the residents. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 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 standard(s) 24,25,26,27,28 Residents live in a homely comfortable and safe environment. Their bedrooms suit their needs and promote independence. The communal rooms and gardens complements and supplement residents individual rooms. The home is clean and hygienic and provides any specialist equipment that is required to maximise independence. EVIDENCE: The home was toured, including all of the residents’ bedrooms. Residents who are able, were seen walking around the home. The home opened in August 2004. It is 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 ensuite toilet and shower. They have been decorated in very individual colour schemes and residents’ interests and hobbies were apparent. Some of the bedrooms have overhead electric tracking for hoists and specialist beds. There is also an assisted bathroom in each of the bungalows. The open plan kitchen/dining area and lounge are spacious and allow the residents, particularly those that are wheelchair dependant to access all areas. The garden is also accessible for all residents, some of whom enjoy watering the plants and weeding. The home was very clean and tidy and free from any unpleasant odours. The manager The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 17 and staff have made a great effort to ensure that the home does indeed feel like home. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35,36 Staffing levels are satisfactory and there is sufficient staff on duty to meet the needs of the residents. But the registered manager must evidence that the long hours worked by the staff are appropriate, safe and in the best interest of the residents. The procedures for the recruitment of staff are robust and provide safeguards for residents living in the home. Staff are appropriately trained to meet the resident’s individual and joint needs. Staff receive appropriate support and supervision. EVIDENCE: Duty rotas were inspected and they correlated with the staff on duty. There are normally six/seven staff on duty on each shift and two waking night staff. All support staff carry out all of the cooking and domestic duties. There were sufficient staff on duty to meet the needs of the residents. The registered manager chooses to cover vacancies and sickness with her permanent staff team. The inspector was concerned at the excessive hours that some of the support workers are working. The registered manager must demonstrate that this is appropriate, safe and in the best interest of the residents. The home has robust recruitment policies and procedures. A requirement from the last inspection was that all staff files kept in the home must contain a complete Criminal Record Bureau check and have an up to date photograph, this has been achieved. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 19 Staff files were inspected and courses that have been undertaken this year include –adult protection, manual handling, health and safety, infection control, self injurious behaviour, person centred planning, understanding communication with people with a learning disability. The registered manager is commencing the NVQ level 4, one senior support worker is completing the NVQ level 3 and six support workers are undertaking the NVQ level 2. Records examined showed that staff receive one to one supervision at least six times a year. All yearly appraisals took place in April and staff meetings take place approximately every six weeks. Staff spoken to confirmed the frequency of their one to one supervisions, appraisals and staff meetings. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,40,42 The home is very well managed and residents benefit as the home is run in their best interests. However it is essential that the registered manager has dedicated time to carry out the day to day managerial duties. The home provides the residents with a safe environment in which to live. The home’s record keeping, policies and procedures safeguard the residents’ rights and best interests. EVIDENCE: The registered manager and senior support workers are experienced and qualified to run the home and demonstrate a very clear understanding of the needs of the residents. The registered manager needs to ensure that she is not rotered to provide hands on care, on all her working days, to enable her to carry out her managerial duties. As stated previously the manager is commencing her NVQ level 4 and one of the senior support workers is completing her NVQ level 3. All the evidence from previous sections of this report points to a well managed home, where the needs of the residents are paramount. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 21 The home is very well maintained and provides a safe environment for residents and staff. All policies and procedures are in place and inspection of records indicated that regular checks to fire alarms and hot water outlets have been carried out. Regular fire drills are also carried out and there is detailed recording about the conduct of the drills. These were requirements of the previous inspection and have been achieved. The registered provider also checks the quality of care in the home through Regulation 26 monitoring visits. A report is produced and a copy is sent to the Commission. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 22 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 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x x Standard No 11 12 13 14 15 16 17 x x 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x x 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Avenues (Neave Crescent) Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x x 3 x 3 x G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 20 Regulation 13 Requirement Timescale for action 31/10/05 2. 33 18 3. 37 10(1) All hand written entries on Medication Administration records (MAR) charts, whether new items prescribed, alterations or items discontinued are to be signed and dated by the person making the entry. The registered manager must 31/12/05 demonstrate that the long hours staff are working are appropriate, safe and in the best interest of the residents. The registered manager must 31/12/05 have dedicated time to carry out her managerial duties. 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 17 Good Practice Recommendations Residents dietry needs and their likes and dislikes are clearly documented in their care plans but good practice would be for these instructions to be written on the menus which are placed in the kitchen. The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex 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. Extracts may not be used or reproduced without the express permission of CSCI The Avenues (Neave Crescent) G55 S60296 The Avenues V248149 260905 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!