Inspection on 11/04/07 for Cromwell Avenue (9)

This inspection was carried out on 11th April 2007.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cromwell Avenue (9) 01/12/05

Cromwell Avenue (9) 01/06/05

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

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

CARE HOME ADULTS 18-65 Cromwell Avenue (9) 9 Cromwell Avenue Cheshunt Herts EN7 5DJ Lead Inspector Alison Jessop Unannounced Inspection 11th April 2007 10:00 Cromwell Avenue (9) DS0000061442.V336279.R02.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 Cromwell Avenue (9) DS0000061442.V336279.R02.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. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cromwell Avenue (9) Address 9 Cromwell Avenue Cheshunt Herts EN7 5DJ 01992 622032 01992 622032 FP 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) Residential Community Care Services Ltd Maria Bridget Walker Care Home 4 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (4) of places Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st December 2005 Brief Description of the Service: 9 Cromwell Avenue is a care home first registered in August 2004, providing personal care and accommodation for four young adults who have a learning disability and associated mental disorder. The home is owned and operated by Residential Community Care Services (RoCCS), a private organisation. This is the third home that RoCCS established in Hertfordshire. The home currently consists of a four bedroom terraced house situated in a residential street in Cheshunt, next door to the GP’s surgery and across the street from a small grocery shop. It is in walking distance of other local shops and parks, and close to public transport. A further bedroom is being added. All the bedrooms are single, with en-suite facilities. The garden contains a patio and grass area, with a pond protected by a small fence, there is also an area at the back of the garden where domestic rabbits and guinea pigs are housed. The current weekly accommodation charge ranges from £1278.00 to £1512.02. A copy of the Service User Guide and Statement of Purpose can be obtained from the manager. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one and a half days by one regulatory inspector. The first day was spent talking to the people who use the service and staff, inspecting care plans and other documentation and inspecting the premises. The second visit was spent with people who use the service, inspecting records relating to recruitment and in discussion with the manager. All residents were at home on the day of the inspection and were happy to offer feedback. Questionnaires were sent to relatives of the four residents, two of which have been returned. Feedback was also gained from two of the resident’s social workers. What the service does well: The home is designed to provide small group or ‘cluster’ living where people who use the service can enjoy maximum independence in a discrete noninstitutional environment. A homely, safe environment is provided to people who use the service who are encouraged to enjoy an independent lifestyle whilst also benefiting from a higher level of person centred care. Staff have an in-depth knowledge of residents needs and offer support in a kind and caring manner. Each resident has their own individually decorated bedroom with their personal possessions being an important part of their identity. People who use the service are encouraged to participate in the running of the household and are also responsible for looking after the homes pets. One resident said, ”‘I like it here, the staff are nice”. Another said, “I like having my own bedroom and I like going out with the staff”. In response to questionnaires, one relative commented that ‘the care home always supports my sister in the best possible way.’ Another stated ‘ she is very well looked after, we have been able to enjoy our lives knowing that she is happy.’ In addition, the Community Nurse assigned to this service also contacted the Commission to declare the high professional regard she has for this service. Care plans are very person centred and all residents have designed a life story using photographs and pictures. One resident was very pleased to show the inspector her book and the collage of photographs on her bedroom wall. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 6 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. Cromwell Avenue (9) DS0000061442.V336279.R02.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 Cromwell Avenue (9) DS0000061442.V336279.R02.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): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. EVIDENCE: Admissions are made on the basis of detailed assessments of the individual’s needs and aspirations so that it is clear that the home can provide a suitable service. The home also has good arrangements to enable new residents to familiarise themselves with the home prior to moving in. An independent living skills questionnaire is completed for each resident to provide a snapshot of individual abilities at the time. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The care plan is developed with, and owned by, the individual, based on a full and up to date holistic assessment. A variety of different and creative methods are used to help people who use the service to contribute in the development of their care plan. Staff use methods to control challenging behaviour that would be regarded as being punitive or inappropriate in different care settings. EVIDENCE: The people using the service understand the information in their care plan. The plan includes photos, pictures and is written in plain language. It is an up to date working tool used by the individual and all involved staff. The care plan can be easily used by people who are not familiar with the individual to deliver a personalised service when necessary. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 10 Procedures relating to medication are satisfactorily maintained and no gaps were observed on medication administration records. An anonymous allegation was received by CSCI, in relation to an incident that occurred whilst residents went out to a café was discussed during this inspection. One resident was referred to by a member staff whilst in her presence as ‘Little Miss Negative.’ She then proceeded to say that the resident was never positive about anything. This is inappropriate and residents must be treated with dignity and respect. However, a relative stated that ‘The staff are very caring and kind and treat all people properly. The care service treat the people with respect and most important is they do treat people fair.’ One resident at the home said, “I just hate it when staff take my things away from me. If I do something wrong then something gets taken away for a week and if I do something else they take it away for two weeks and then three weeks”. This approach was later described as being wholly appropriate by a qualified external professional. However, during the site visit, staff were questioned about this and the response was ‘she agreed that when she misbehaves this is what we will do.’ Staff used the term ‘misbehaved’ on several occasions throughout the inspection. It was pointed out to them that this terminology is not usually associated with adults. People who use the service should be approached in a more dignified manner. An example of good practice was that one resident requested to go to the barbers to get his haircut. The service user has an Italian background and staff supported him to go to the local Italian barber. He also said ‘I go to the church on a Sunday with my family, I like going with them.’ People who use the service are involved in running the home and assist with domestic chores, cooking and general day to day tasks. Residents stated that they are able to choose what they would like to eat and what activities and outings they would like to go on. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home understands the importance of enabling younger adults to achieve their goals, follow their interests and be integrated into community life and leisure activities in a way that is directed by the person using the service. EVIDENCE: People who use services are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. One resident said ‘I like going to the pub and cinema and on holiday to Butlins.’ Other activities that have been enjoyed include shopping trips, picnics in the park, trips to the seaside and tours around London. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 12 The service actively supports people who use services to be independent and involved in all areas of daily living in the home. This includes where appropriate, taking responsibility for shopping, planning meals, and meal preparation. People who use the service are very much encouraged and supported to maintain relationships with family and friends. One resident said that her sister stays with her at the home regularly which she really looks forward to. One relative stated ‘The care service supports the clients in all sorts of ways for example they can choose to go to college or other support groups or learning skills.’ The home has several pets. One resident said she takes responsibility for cleaning out and caring for the pets, which she said she enjoys very much. The manager stated that concerns expressed by the inspector about some restrictions on rights has in fact encouraged the service user to understand socially acceptable behaviour. Although it was agreed that boundaries must be in place, within a risk management framework, resident’s rights must not be compromised. Meals are very well balanced and highly nutritional and cater for varying cultural and dietary needs of the people who use services. Residents are involved in meal planning and have a wide variety of choice on offer from pictorial menu cards. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use service the service receive effective personal and healthcare support using a person centred approach. Resident’s individual plans clearly record their personal and healthcare needs and detail how they will be delivered. EVIDENCE: Staff members are very alert to changes in mood, behaviour and general wellbeing. The manager stated that all of the residents since living at the home have developed ways in which to manage their feelings. People using the service receive a weekly reflexology and aromatherapy session with a qualified therapist who is familiar to all the residents. The home has developed efficient medication policy, procedure and practice guidance. The home works closely with external professionals and specialists for advice and support to help the resident, their family and the homes staff. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows residents to express their views, and concerns in a safe and understanding environment. EVIDENCE: The service has a complaints procedure that is clearly written and easy to understand. No complaints have been received by the home since the previous inspection. One anonymous concern was raised with the Commission for Social Care Inspection and was discussed with the manager during the site visit to the service. Training of staff in the area of protection is regularly arranged by the Home. Other training around dealing with physical and verbal aggression is also made available to staff. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable and well maintained. EVIDENCE: The home is designed to provide small group or ‘cluster’ living where people who use services can enjoy maximum independence in a discrete noninstitutional environment. Each resident has a bedroom with en-suite facilities. Residents are supported to keep the home clean and tidy. Bedrooms are individually decorated and residents are encouraged to display personal possessions in all areas of the home. A further bedroom is currently being developed and internal decorating is planned for the hallway, lounge and kitchen. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service has plentiful staff available at all times to support the needs, activities and aspirations of the people using the service in an individualised and person centred way. EVIDENCE: The service is proactive rather than reactive in its staffing, recruitment and training. The scheme introduces internal developmental training, to complement formal training as part of an ongoing training plan. The staff team support each other and share skills and knowledge with colleagues. Managers from the two other ROCCS homes provide training to staff during their induction period. It is recommended that staff receive formal training on Valuing People as this may assist staff to develop their use of language when referring to and conversing with service users. Records relating to recruitment were satisfactory. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 17 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): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has the required qualifications and experience and is competent to run the home. There is a strong ethos of being open and transparent in all areas of running the home. EVIDENCE: The registered manager has an in-depth knowledge of the residents’ needs and looks at various ways in which to improve the lives of the people who live there. The manager must seek more appropriate ways in which to ensure the dignity and rights of the people using the service are respected and it was recommended that residents might benefit from independent advocacy services. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 18 The quality assurance process is robust and provides various methods for residents, relatives and other visitors to the home the opportunity to express their views. Residents and relatives complete an annual survey. Although formal house meetings are not held the staff team felt that residents were more able to express their views during day-to-day activities and during meal times. Any suggestions or comments are noted and action taken by staff. The proprietors visit the home on a day-to-day basis and carry out a monthly quality audit. Staff meetings are also held every two months. Procedures and records in relation to health & safety are adequately maintained. On the day of the inspection the fire alarm sounded as this was triggered by maintenance work being carried out. Although this was a false alarm the staff dealt with this in a competent manner, protecting residents from harm. On the day of the inspection one of the residents kicked a football into the garden pond. The resident was able to access the pond and lent over to retain the ball. The member of staff stated that the gate should have been locked. The risk assessment on the garden pond must be reviewed and service users must be protected. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 19 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 4 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 3 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 X 3 X X 2 X Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 20 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 YA42 Regulation 13(4)(c) Requirement The risk assessment on the pond must be reviewed. Timescale for action 11/08/07 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 YA35 Good Practice Recommendations It is recommended that all staff receive training on valuing people. Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Cromwell Avenue (9) DS0000061442.V336279.R02.S.doc Version 5.2 Page 22 - 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!