Inspection on 20/02/06 for Chelwood Avenue (7)

This inspection was carried out on 20th February 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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chelwood Avenue (7) 22/07/09

Chelwood Avenue (7) 24/07/08

Chelwood Avenue (7) 28/06/07

Chelwood Avenue (7) 16/11/06

Chelwood Avenue (7) 09/06/05

Chelwood Avenue (7) 29/10/04

Chelwood Avenue (7) 22/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Chelwood Avenue (7) 7 Chelwood Avenue Childwall Liverpool Merseyside L16 3NN Lead Inspector Peter Cresswell Unannounced Inspection 20th February 2006 8:45 Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 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 Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 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. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chelwood Avenue (7) Address 7 Chelwood Avenue Childwall Liverpool Merseyside L16 3NN 0151 722 2854 9999 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) www.c-i-c.co.uk. Community Integrated Care Mr Colin Smith Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th June 2005 Brief Description of the Service: Chelwood Avenue is home to two adults with learning disabilities run by Community Integrated Care, a major local not-for profit organisation. Although the home is registered for three service users only two bedrooms are now available and there are no plans to admit a third service user. 7 Chelwood Avenue is a semi-detached house in a quiet suburb of Liverpool, close to a small parade of shops, the M62 and bus routes to Liverpool city centre. Downstairs there is a large lounge, dining room and a kitchen. Upstairs there are two spacious single bedrooms, a bathroom and a small room that is currently used as a staff sleep-in room. The former garage has been converted to an office and utility room There is a large garden to the rear and side of the house. One of the service users has a minibus that is used for both service users, with the other making a financial contribution to its running costs. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector met one of the service users and spoke to the acting manager and both staff who were on duty. He examined medication and documents relating to recruitment, training, fire safety and service users’ finances. He looked at all of the rooms in the house. What the service does well: 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. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 6 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 Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 7 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): 2. The Registered Person has assessment procedures which would ensure that new service users were appropriately admitted to the home, should that eventuality arise. EVIDENCE: The present service users have lived at Chelwood Avenue for many years now so no new admissions have been made. The company has an assessment procedure which would be used in the event of a new admission. The service users are tenants of Maritime Housing, which owns the property. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9. Care planning is good, providing staff with the information they need in order to provide appropriate support for the service users. EVIDENCE: The service users have limited communication but they and their families are always consulted about events that might affect their lives. Neither service user is able to go out independently but both are encouraged to go out with staff and family and take assessed risks appropriate to their capacity. A stair gate is fitted to the top of the stairs to prevent the possibility of a fall. The gate allows staff to restrict access to the stairs when the service users are in their rooms. The last report stated that fitting such a measure was an appropriate response to the risk but required a risk assessment to be completed, with a copy forwarded to the Commission for Social Care Inspection. This has not yet been received. This does raise the question of whether a semi detached two-storey house is the best physical environment for service users to whom stairs present a problem. This matter should be kept under review and the service users, their families and, where appropriate advocates, should be fully involved in any reviews. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14, 15, 17. The home supports and provides appropriate activities to meet the needs and likes of the service users. EVIDENCE: The service users take part in a range of activities and are encouraged to develop and retain everyday living skills to the best of their abilities. They use local community facilities such as local shops, supermarkets and parks with the support of staff. They enjoy individual activities but also go out together in the minibus. This belongs to one of the service users but arrangements have now been made for the other person to make a contribution to its running costs, reflecting the fact that they both have use of the vehicle. However, the charge made does not seem to be proportionate and the Registered Person should review this situation. One service user has now resumed attending a day centre and goes two full days a week and two hours on Thursdays. The acting manager said that she believes that the resident would enjoy more time at the day service, and he always enjoys going there. This should be considered in full at the next review and, if agreed, the day centre hours should be increased. Activities are now recorded on file, and staff liaise with day centre staff about activities in which the service user takes part. The acting manager Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 10 has devised new activity plans for both service users and is planning to develop the plans over the coming weeks. The service users see their families as often as they and the family wish and family members visit the home regularly. The menu is based on those meals that the service users have previously enjoyed and the record of what has been served shows that the meals are varied and nutritious. The service users go shopping with members of staff. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Staff have a good understanding of the service users’ personal support needs and provide support accordingly. Medication procedures need some minor improvements in order to further ensure the protection of the service users and the manager has this process in hand. EVIDENCE: Personal support is provided in privacy and in accordance with the care plan. The service users receive all the community and specialist medical care and support that they need, including visits from a Community Psychiatric Nurse Neither service user retains their own medication. The acting manager is moving towards a monitored dosage system for as much medication as possible, which should avoid some of the problems of over-ordering and inconsistency in recording that were noted at the last inspection. The administration of medication was properly recorded but it was again evident that some medication is re-ordered when stocks are already available, which can make it difficult to fully account for everything prescribed. Medication is administered to one of the service users in food, as he is otherwise reluctant to take it. This is clearly seen to be in the best interests of the service user. However, this type of covert administration should only be carried out in accordance with the guidance of the relevant section of the Royal Pharmaceutical Society’s publication ‘The Administration and Control of Medicines in Care Homes and Children’s Services’ (para. 6.2.2). This states Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 12 that such decisions should be made following a decision by a ‘multi professional team’, should be recorded in the care plan and reviewed. As this practice has been used for some time and is perceived to be in the service user’s best interest it clearly should not be stopped, but the manager should get written authorisation from the service user’s GP or other relevant medical professional involved with the service user’s care and keep the procedure under review. The home should also obtain a copy of the RPS Guide, as recommended at the last inspection. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 13 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): 23. The home has satisfactory procedures for the prevention of the abuse of vulnerable adults to protect the interests of the service users. EVIDENCE: The owners have well-established procedures for the investigation and prevention of adult abuse. Since the last inspection four members of staff have been suspended following allegations of possible abuse. None of the allegations have been substantiated and only one member of staff is currently suspended but they have revealed shortcomings in the way in which the home was managed. The most recent incident was dealt with in line with POVA procedures and it was decided, in consultation with Social Services and the Primary Care Trust that a strategy meeting was not appropriate. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30. The home provides a comfortable and homely environment for the service users. EVIDENCE: Chelwood Avenue is a domestic semi detached house that blends in with the surrounding area and is furnished in an appropriate, homely style, though some compromises have been made to meet the particular needs of the service users. Most floors, for instance, have a laminate surface that meets the needs of the service users whilst still looking homely and attractive. The large garden is used in warmer weather, though one of the service users finds it difficult to walk on the lawn that comprises most of the garden. The garden would therefore be more accessible to the service users if part of it was given a hard surface. The service users’ single bedrooms are spacious, well furnished and personalised to some extent to reflect the tastes of the individual. The large bathroom is attractively decorated but the corner bath is not entirely suitable for the needs of the service users and the possibility of a replacement is being considered. The shared lounge and dining room are well furnished and comfortable but the wallpaper in the dining room has been badly scratched by one of the service users. Although the wallpaper is relatively new it does need to be replaced if the home is to retain its intended homely atmosphere. Given some of the behaviour of the service users the home clearly needs to be Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 15 redecorated more frequently than the average house. The sofa in the main lounge has partly collapsed and is propped up by telephone directories, apparently on the – rather surprising – advice of the suppliers. This is clearly unsatisfactory and the sofa should either be repaired or replaced. One of the service users has knocked the very large television off its stand more than once and the Registered Person should investigate ways of making it more secure. The service user’s vehicle has been damaged several times as the entrance to the driveway is very narrow and it leads on to a narrow, well-used road. It would be sensible to widen the gateway to avoid this problem. The third bedroom is nowadays used as a staff sleep-in bedroom. As pointed out in the previous report the room is no longer available for use by a service user and it would be appropriate for the Registered Person to apply for a variation to reflect the fact that the home can now only accommodate two service users. The home was clean and odour free. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Staff recruitment procedures help to ensure that suitable staff are available to meet the needs of the service users. More staff with NVQ2 and more training in control techniques are needed to ensure an appropriate level of qualified staff. Staff supervision is helping to rebuild a staff team which can continue to meet the service users’ assessed needs. EVIDENCE: Recent events, including the suspension of four staff, have revealed some problems in the management of the staff team. Two staff that were suspended are now back at work, one has moved to another establishment and the fourth was only recently suspended. A number of new staff are now in place (all but one having come from other CIC services). The acting manager is maintaining detailed training records for all of the staff and is arranging additional training in control techniques as the latest staff suspension arises from allegations about inappropriate handling. The case is still being investigated. Four of the staff team have NVQ2, still slightly short of the National Minimum Standard of 50 . The manager is arranging regular team meetings and staff are being supervised every two months. Records are kept of the meetings and supervision sessions. Staff have responded well to the challenges posed by recent events and the staff on duty were enthusiastic and well motivated. One new member of staff had been recruited to CIC since the last inspection and recruitment records were in order. The CRB and POVA First checks were not kept on the premises but evidence of the CRB having been Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 17 completed was on file and evidence of the POVA First was faxed to the home during the inspection. The home is normally staffed by three care staff when both service users are in, though this can be reduced to two when only one service user is in the house. The manager said that this can create some difficulty on Thursdays when one service user goes to a day centre for just two hours and this situation should be reviewed. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 18 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, 38, 39, 42. The home is well managed by the acting, part time manager, but fire safety procedures are not up to date, creating a possible area of risk for the residents. The absence of a permanent manager could create uncertainty for service users and needs to be addressed. EVIDENCE: The former (unregistered) manager has now moved on to other duties within the organisation and the acting manager works at Chelwood Avenue for up to three days a week whilst continuing to manage another small home (for which she is registered). The acting manager is qualified, experienced and shows a very good grasp of the issues involved at the home. In the circumstances the manager has done well to develop the level of care and motivate the staff team. However, it must now be a priority for the Registered Person to recruit a qualified, competent, full time manager for the home. Service users are involved as far as possible in the everyday affairs of the home and families are consulted where appropriate. The Registered Person has a system for the regular review of policies and procedures. Service users’ Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 19 finances are properly managed though there are issues relating to the costs of the vehicle which are referred to earlier. Fire safety checks were out of date and had not been recorded regularly; it is important that these checks are recorded. Accidents are recorded in an Accident Book designed by the owners, which does not comply with the Data Protection Act. It would be advisable for the owners to obtain an Accident Book with removable pages that can be filed separately. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 20 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 X 2 3 3 X 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 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 3 3 X X 2 X Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 16 and 23 Requirement Timescale for action 01/05/06 2. YA37 8 3. YA42 23(4) The Registered Person must ensure that the home has adequate furniture and is reasonably decorated and must therefore: *Replace the damaged wallpaper in the dining room; *Repair or replace the broken sofa in the lounge; *Secure the TV in the lounge; *Make the garden fully accessible to both service users, if necessary by providing a hard surface to apart of the garden. The Registered Person must 01/05/06 arrange for the appointment of a permanent manager who will apply to be registered by the Commission for Social Care Inspection The Registered Person must take 21/02/06 adequate precautions against the risk of fire and must therefore ensure that staff regularly check fire safety equipment and procedures and record such checks. Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA9 YA14 Good Practice Recommendations The manager should forward to the CSCI a copy of the completed risk assessment about the stair gate. The attendance of the identified service user at the day centre of his choice should be reviewed and, if it is judged to be in his best interests, the hours of attendance should be increased. The funding of the vehicle should be reviewed again to ensure that costs are shared proportionately. The home should: * Obtain the signed agreement of a medical practitioner for the administration of medication in food where this is considered necessary, and keep the situation under review; * Obtain a copy of the Royal Pharmaceutical Societys guide to the administration of medicines in care homes. A wider entrance to the drive would help to ensure that the service user’s vehicle is not scratched. The Registered Person should apply for a variation to ensure that the homes registration is consistent with its capacity. The home needs additional staff with NVQ2 to meet the standard of 50 of care staff with the qualification. The Registered Person should review the level of staffing on Thursday mornings to ensure that the service users needs can be fully met. 3. 2. YA14 YA20 3. 4. 5. 6. YA24 YA25 YA32 YA33 Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Chelwood Avenue (7) DS0000025236.V283938.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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