CARE HOME ADULTS 18-65
Craignish Avenue (4) 4 Craignish Avenue Norbury London SW16 4RN Lead Inspector
Lee Willis Unannounced 23 September 2005 08:30am
rd 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. Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Craignish Avenue (4) Address 4 Craignish Avenue, Norbury, London, SW16 4RN 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) 020 8679 8951 020 8679 1096 Mrs Hannah Miller - London Borough of Croydon Care Home 5 Category(ies) of LD Learning Disability 18-65 years (5) registration, with number of places Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th December 2004 Brief Description of the Service: Craignish Avenue is owned, managed and staffed by the London Borough of Croydon. The Centre is registered with the Commission for Social Care and Inspection to provide short-stay respite care for up to younger adults with mild to moderate learning disabilities. There are approximately fifty individuals who currently use the Centre on a regular basis, although the duration and frequency of their stays varies considerably. Care managers representing the Local Authority are responsible for assessing individual service users needs and making referrals to the centre. Claire Adam has been in operational day-to-day control of Craignish Avenue since January 2005 and has recently undergone a fit person interview with the Commission to register as the centres new manager. Craignish Avenue is a semi-detached terrace property situated in the heart of Norbury, which has a wide range of local amenities, including shops, eateries and good public transport links. The centre is less than ten minutes walk from a local train station and numerous bus stops with direct links to Croydon, central London and the surrounding areas. The property itself comprises of five single occupancy bedrooms, located on the first and second floors, a front lounge, open plan dinning/kitchen area, staff sleep-in room, and ground floor office. There are sufficient numbers of toilet and bathing facilities located throughout the property. The front of the premises has recently been redecorated and there remains ample space for parkng vehicles on the front drive. There is a well maintained garden at the rear.
Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection began at 8.30am in the morning of Friday 23rd September 2005 and was conducted over two and a half hours. Four service users were met during the course of this visit, of whom two were spoken to at length. Since April 2005 the Commission has received fifteen comment cards in respect of the service, over of half of which were completed by the service users and the rest by their relatives. Some of the service users also had help from their representatives filling out these cards. As part of the inspection process the relatives of two of the service users were also contacted by telephone to ascertain their views about Craignish Avenue. The majority of the actual visit was spent talking with the new manager, a member of staff who had worked as a carer at the centre for many years, a service user and their relative who were visiting at the time, and as previously mentioned, three of the service users who had slept over. The remainder of the visit was spent examining records and touring the building. No additional visits or complaints investigations have been carried out by the CSCI in respect of this service in the past twelve months. What the service does well:
The relatives of two of the service users spoken to over the telephone both said they were extremely satisfied with the standard of care being provided by the Centre, and in particular with the attitude of staff. Furthermore, the overwhelming majority of the comment cards returned to the Commission from service users and relatives were very positive about the overall standard of care provided. One service user wrote, “I enjoy my stays at Craignish Avenue very much and I always want to go back”. Having arrived during breakfast the atmosphere at the centre felt extremely relaxed and unhurried with service users helping themselves to a wide variety of cereals and hot drinks as and when they came down for breakfast. It was evident from care practises of staff observed that they continue to actively encourage and support the service users to maximise their independence and make as many ‘informed’ choices about what they do during short stays at the centre as possible. Two of the service users met said they could choose when to get up, go to bed, what they did and when and what they ate while at the centre. One service user also said staff always took into account there wishes and the member of staff on duty confirmed that the previous weekend everyone residing at the centre voted to go ten pin bowling instead of going to the cinema. It was evident from the way the service users and the members of staff interacted with one another that good working relationships had been built up over time. The service users who regularly stay have all benefited from the
Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 6 fact that centre continues to experience relatively low rates of staff turnover. The two members of staff on the early shift, which included the manager, had both worked on and off at Craignish Avenue for the past ten years and were consequently very familiar with the centres daily routines and the unique wishes and needs of the vast majority of the fifty or so service users who regularly access the service. 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.
Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.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 Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.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 & 4 The centres Statement of purpose and guide provides prospective new service users and their representatives with all the information they need to know about the suitability of the project, although this document will need to be updated to reflect recent changes in management and staff personal. Admission procedures are sufficiently robust to ensure that prospective service users individual aspirations and needs are thoroughly assessed prior to the staying at the centre. This information will enable staff to plan for and meet identified needs and aspirations. EVIDENCE: The centres Statement of purpose and guide provides prospective new service users and their representatives with all the information they need to know about the service. The new manager is aware that this document will need to be kept under review and updated accordingly to reflect all the changes that have occurred since the centres last inspection in December 2004. The new manager has worked at Craignish Avenue for the past ten years and consequently was familiar with the centres admissions criteria and procedures. The manager said that service users whose needs or circumstances have significantly changed are reassessed and a review held to discuss the suitability of the placement. The new manager was very clear that she would not accept anyone whose needs the centre was clearly not capable of meeting.
Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 9 A member of staff spoken with said prospective new service users are always invited to visit the centre and stay for tea before deciding whether or not to stay. It was positively noted that during this unannounced inspection a service user, who had not stayed at Craignish Avenue for sometime, was revisiting with their mother to reacquaint themselves with the place. Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 7 Care plans accurately reflect the service users personal, social and health care needs, as well as their likes and dislikes, ensuring staff can plan for and met them. Suitable arrangements are in place to ensure the service users wishes about how the centre is run are taken into account. EVIDENCE: Care plans sampled at random had all been recently updated and the format amended by the new manager to make them more person centred. Plans contained far more detailed information about each individual service users wishes, including their food preferences and social/leisure interests. The manager said this was a work in progress, but was confident all the plans would be updated by the end of the year. According to the centres records the last service users meeting was held on 18th September 2005. Topics discussed ranged from ideas for indoor activities, day trips and menu planning. One service user met said these meetings are held every Sunday and are always well attended by service users staying over and staff on duty at the time. Another service user said they liked the staff working at Craignish Avenue and felt able to talk them about anything.
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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) 12, 14, 16 & 17 The number and range of social, leisure and recreational opportunities the service users have to engage in, both at the centre and in the wider community, are extremely varied and based on service users wishes. Dietary needs are well catered for, nutritionally balanced, and clearly based on personal preferences. EVIDENCE: All three of the service users who had stayed over at Craignish Avenue the previous night were in at the time of this unannounced early morning inspection. One service user who was sitting in the lounge said he had just finished his breakfast and was now waiting for his taxi to take him to the day centre. He went onto to say he had made his own breakfast and decided to have cereal chosen from number boxes stored in the kitchen cupboards. Another service user who was seen helping them self to bowl of cereal said he was planning to walk to Croydon town centre that morning and have lunch out. A third service user, who was also observed helping themselves to breakfast, said they would be going to a day centre. It was positively noted that the manager had realised this particular individual was running a little late and having consulted the service user on the matter it was agreed that she would
Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 12 contact the day centre on his behalf to inform them he was going to be a little late. Having toured the kitchen ample stocks of fresh food, including fruit and vegetables, were noted to be correctly stored in accordance with basic food hygiene standards. As previously, mentioned service users are encouraged to prepare their own breakfasts whenever they get up. Breakfast times are therefore reasonably flexible and the atmosphere remained relaxed and unhurried throughout the course of the morning. The two service users spoken to at length both said there was always plenty of things to do and eat at Craignish Avenue and that they particularly enjoyed the regular day trips and evening outings. A member of staff said the service users had all voted to go bowling last weekend instead of going to the cinema, which had been the initial plan. The service users and staff met all said its great having such good bus and rail links located so near the centre. One service user who was going to walk into Croydon said he would probably get the bus back as it would drop him off almost out the centre. It was positively noted that the centre has recently purchased a new DVD player for the front room in response to the decision by many video retailers not to stock films on video anymore. Furthermore, all the bedrooms have now been provided with televisions and the manager said these had proofed very popular, especially late in the evening when many of the service users often want to spend some quality time alone in the privacy of their bedrooms. Since the last inspection all the service users who regular use the centre have been consulted about its rules on smoking and it was unanimously agreed that the centre should become a no-smoking house. Service users, their guests and staff who smoke may do so in the rear garden. The manager has written a policy statement to this effect and is aware that it must be kept under constant review and up dated accordingly to reflect agreed changes to this rule. Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.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 Suitable arrangements are in place to ensure the service users physical and emotional health care needs are identified, planned for and met, and records appropriately maintained of any accidents and/or incidents they are involved in. EVIDENCE: Records revealed that suitably trained staff had promptly dealt with all the accidents involving service users during their time at the centre. There had been sixteen incidents/accidents since the beginning of the year, the majority of which were minor with no major injuries sustained. Nevertheless, two accidents involving service users had been more serious with one service user admitted to accident and emergency having fallen over whilst bowling and another falling over in the shower. It was positively noted that individual risk assessments had been reviewed and up dated accordingly to minimise the likelihood of similar incidents reoccurring. The manager said that the needs of one service user had significantly changed and the suitability of their placement was in the process of being reviewed by their care manager and all the other concerned parties. Since the centres last inspection all the radiators have been assessed and covered as necessary to minimise identified risks.
Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 14 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 Suitable arrangements are in place to ensure the service users are listened too and any concerns they have about the centres operation are acted upon in accordance with the Local Authorities complaints procedures. The centres vulnerable adult protection and abuse prevention measures are suitably robust to ensure the service users are, so far as ‘reasonably’ practicable, protected from abuse, neglect and/or harm. EVIDENCE: The centres complaints log revealed that there had been no complaints made about its operation since the last inspection in December 2005. One service user met said staff always ask him to complete a satisfaction questionnaire every time he stays. Consequently, any concerns people may have tend to be identified at an early stage and responded to before the problem is allowed to escalate. The manager said individuals often use weekly service user meetings to express any concerns they may have. There have been no allegations of abuse at the centre in the past twelve months or staff referred for possible inclusion on the Protection Of Vulnerable Adults register (POVA). The new manager was aware of her responsibilities regarding vulnerable adult protection and the local authorities role in dealing with alleged or suspected incidents of abuse. Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 15 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, 26, 27 & 29 The overall layout of the centre, which is furnished and decorated to a reasonable standard, ensures the service users have a comfortable environment in which to stay. Nevertheless, due to changing needs the premises will need to be assessed by a suitable qualified occupational therapist and any recommendations made implemented to ensure everyone’s stay is, so far as reasonably practice, a safe one. Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 16 EVIDENCE: Since the centres last inspection there have been significant changes made to the premises with all the windows on the ground floor at the back of the property replaced with new double glazing, the exterior window sills painted, and the existing front door reinforce and fitted with window protectors in order to meet new fire regulations whilst maintaining the security of the building. Two of the service users spoken to at length said the bedrooms they occupied when they stayed over contained every thing they needed. One service user said he liked having a television in his room, which he could watch at night. Having been on a brief tour of the premises it was positively noted that all three of the bedrooms viewed at random were decorated to a ‘reasonable’ standard in a variety of different colours, which made them more individual. Using the centres thermometer the temperature of the water emanating from a showerhead attached to the first floor bath was found to be a safe 41 degrees Celsius at 10.55am. The manager was aware that hot water temperature used in baths and showers must never exceed 43 degrees Celsius to comply with health and safety regulations. It was evident from the centres incident book and comments made by the manager and staff that some of the service users physical needs had changed. Having been on a tour of the centre it was agreed that a suitably qualified occupational therapist would need to carryout a thorough assessment of the premises, in particular the centres bathing/shower facilities, and any recommendations made in the subsequent report acted upon. Having discussed this matter with the manager and a member of staff on duty at the time that one of the centres bathrooms could be suitably adapted to meet all the service users mobility needs, all of whom remain ambulant. Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Due to time restraints none of the standards relating to staffing were assessed on this occasion, although it was positively noted that sufficient numbers of suitably experienced and trained staff, including the new manager, were on duty at the time of this unannounced early morning visit. EVIDENCE: Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 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 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 & 42 In the main the homes health and safety arrangements are sufficiently robust to ensure potential risks to service users, their guests and staffs health are, so far as reasonably practicably, minimised. Nevertheless, the homes gas installations still need to be tested by a suitably qualified engineer on a more frequent basis to ensure it complies with health and safety regulations. EVIDENCE: The centres new manager, Claire Adam, has worked at Craignish Avenue in a senior management capacity for the past ten years and is consequently very familiar with the organisations policies, individual service users needs, as well as staff strengths and weaknesses. Claire has recently undergone a ‘fit’ person interview with the Commission to register as the centres new manager and is on course to have completed the management component of the registered managers award by the summer of 2006. There are clear lines of accountability within the local Authority and the new manager says her line manager is always on hand to offer support and advice as and when required.
Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 19 The fire risk assessments for the building were recently reviewed and updated following a visit from the Local Authorities health and safety representative. It was noted that none of the centres fire resistant doors had been fitted with effective smoke seals, although all the doors tested at random fit closely into their frames. The manager said this issue had already been raised and progress on this matter will be assessed at the centres next inspection. Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x 3 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 3 x 2 x Standard No 11 12 13 14 15 16 17 x 3 x 3 x 3 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Craignish Avenue (4) Score x 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 21 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 1 Regulation 6(a) Requirement The centres Statement of purpose and service users guide must be kept under review and up dated accordingly to reflect any changes. A suitably qualified occupational therapist must be invited to carry out an thorough assessment of the premises and any recommendations made in the subdequent report acted upon. Timescale for action 1st November 2005 1st January 2005 2. 29 12(1)(a) & 13(4) 3. 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 37 42 Good Practice Recommendations The new manager should have achieved the management component of her NVQ Level 4 training by mid 2006. The local fire authority should be consulted about the appropriateness of fitting smoke seals to all the centres fire resistant doors. Craignish Avenue (4) G53-G53 s39500 CraignishAv v215251 230905.doc Version 1.40 Page 22 Commission for Social Care Inspection Croydon, Kingston & Sutton Office 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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