Inspection on 06/12/06 for Cumberland Avenue Residential Home

This inspection was carried out on 6th December 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cumberland Avenue Residential... 06/10/08

Cumberland Avenue Residential... 16/02/06

Cumberland Avenue Residential... 14/07/05

Cumberland Avenue Residential... 31/01/05

Cumberland Avenue Residential... 11/08/04

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

CARE HOME ADULTS 18-65 Cumberland Avenue Residential Home 31 Cumberland Avenue Bury St Edmunds Suffolk IP32 6TG Lead Inspector Deborah Kerr Unannounced Inspection 6th December 2006 10:00 Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cumberland Avenue Residential Home Address 31 Cumberland Avenue Bury St Edmunds Suffolk IP32 6TG 01284 725972 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.mencap.org.uk Royal Mencap Society Mrs Caroline Joyce Smith Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th February 2006 Brief Description of the Service: 31, Cumberland Avenue is a six-bedded care home for adults with learning disabilities. It is located in a residential part of Bury St. Edmunds and is situated in a quiet road with access to green areas nearby. The home is close to local shopping facilities and a short car or bus journey from the centre of Bury St. Edmunds and all the resources offered there. Mencap provide the staffing and administration and lease the home from Suffolk Housing Association. The home was first registered in 1994 and provides spacious and modern accommodation for the residents. The home has a detailed statement of purpose and service users guide, which provide information about the services provided. Each service user is issued with a licence to occupy setting out their basic rights and responsibilities with the Housing Association and Mencap. The current fees range between £597.97 and £806.73. Not included in these fees are service users own personal items such as toiletries, clothes, hairdressers, chiropodist, theatre trips, concerts, holidays and meals outside of the home. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on a weekday afternoon and early evening lasting seven hours. This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from the service users ‘Have your say about’ and 5 relatives/visitors comment cards. The home’s Statement of Purpose and Service Users Guide were reviewed and a number of records including those relating to service users, staff, training and health and safety records. Time was spent with all six service users, the deputy manager and three staff. We are currently testing a method of working where ‘Experts by Experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ is used to describe people whose knowledge about social care services comes directly from using them. Marion Ryan an Expert by Experience joined the inspector on this site visit. Marion’s comments and observations are added to this report and can be identified in bold text. What the service does well: What has improved since the last inspection? The statement of purpose and service user guide has been updated to reflect that one service user has been diagnosed with dementia and continues to live in the home. Staff have received training from the Alzheimer’s Society to ensure they have the knowledge and skills to meet the service user’s changing needs. Staff files showed that relevant police checks and Protection of Vulnerable Adults (POVA) were being obtained prior to staff commencing employment. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Quality in this outcome area is good. Prospective service users can expect to have detailed information about the home, however can not expect to have an up to date contract which reflects the current fees and rent charged by Mencap and Suffolk Housing Authority. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since 2004. Therefore it was not possible to fully assess standards two to four. The statement of purpose and service user guide provides detailed information about the home’s admission procedure, which is supported by Mencap’s admissions policy. The statement of purpose and service guide have been updated to reflect that one service user has developed the condition of dementia and is being supported to continue to live at the home. The Alzheimer’s society and other health professionals have visited the service user at home to assess the environment and have developed a plan of care that will continue to meet the service user’s needs. A representative from the Alzheimer’s society has provided training for staff to ensure they have the skills and experience to understand the changing needs of the service user. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 9 Two service users ‘Have your say’ comment cards reflected that they did not know about their contract and information provided about the home. The ‘licence to occupy’ agreement between the service users, Mencap and Suffolk Housing Association had not been changed to reflect current rent charges and fees. These had not been updated since the service users had first moved into the home dating back to 1998. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Quality in this outcome area is good. Service users can expect to have care plan’s that reflect their lives, personal goals and identify their changing needs. They can also expect to be supported to take risks, which enable them to lead positive and fulfilling lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans seen were comprehensive covering all aspects of service users health, social and welfare needs. These are in the process of being redesigned using the person centred planning (PCP) approach. Each service user has three files, a current ‘live’ file, PCP support file and a risk assessment file. Service users have been encouraged to take part in the creation of their care plan. One service user showed the inspector their ‘Diary of Life’ this was their own current file, which was made up of photographs and reflected a portrait of the service users life, bringing together all of the people important to them such as family, friends and support workers. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 11 The PCP support plans identified the level and support service users required and the interventions staff needed to take to meet their individual needs. These described the service users’ daily routines stating what they could do for themselves, their preferences and activities they participated in. These were linked to a range of assessments, which enabled the service users to take risks, for example preparing food and accessing public transport. Risk assessments are discussed and agreed with the service user to minimise risks and ensure their personal safety but still allowing them to take part in their chosen activity. Two plans reflected changes in service users’ behaviour due to hormonal and medication changes. There were no agreed plans in place for staff to manage this behaviour. The deputy manager confirmed this was to be discussed at the next staff meeting and that advice had been sought from the service users’ general practitioner and other specialist teams. Discussion took place with the deputy about the need for established individualised procedures, which have been discussed and agreed with the service user for dealing with incidents of inappropriate behaviour. These procedures must be recorded in their support plans with clear guidelines as to what actions staff should take in each circumstance to protect themselves and the rights and best interests of the service users. The expert by experience was invited to join service users for their evening meal. They joined in the general conversation and established that each service user is supported to make choices and decisions about their daily routines. Service users told the expert by experience they could choose when they go to bed and when they get out of bed in the morning. All service users had front door keys, apart from one who requires staff support when out of the home and did not wish to have their own key. Service users do the housework, mostly on a rota basis and help staff to prepare food to cook the main dinner. Service users have freedom to play music in their rooms and in the lounge and can choose what to watch on TV. Risk assessments showed that service users had limited understanding of financial matters and required support to manage their finances. A financial folder and personal money records of all transactions are maintained and showed that service users are in receipt of benefits including disability living allowance (DLA), pension credits and their personal allowances. Each had a current and savers account and had standing orders arranged for payment of rent and fees. A service user and a member of staff had returned from shopping and were seen entering details of their purchases and change into their financial folder. Spending money was withdrawn from their current account and recorded in their personal monies sheet. All transactions require two staff signatures. The records and balance of the service users money was checked and found to be accurate. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 12 A recent residents meeting had taken place in August 2006 where a range of issues had been discussed about the home, mealtimes and Christmas. The deputy manager confirmed the last resident meeting took place in April 2005. For service users to be fully consulted and enabled to participate in the dayto-day running of the home these meetings should take place on a more regular basis. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,1,4,15,16,17, Quality in this outcome area is good. Service users continue to be supported to have appropriate and fulfilling job opportunities and to mix with other adults in appropriate activities within the local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users were keen to tell the expert by experience what they had been doing during the day. They had spent the day at various placements offering day care facilities or opportunities for work. One service user works at the Bury St Edmunds resource centre doing reception work. Another service user has commenced a service to business placement, which is funded by social services, where they are employed to help pack information for businesses. A few of the residents go to college. This was confirmed in the ‘Diary of Life’ of one service user. Photographs provided evidence that the service user attended the West Suffolk College where they had learnt how to make greetings cards. They provided samples of some of the cards they had made. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 14 Other photographs showed outings to various places of interest, including a Wildlife Park, a meal out to the Tollgate Inn, a Hog Roast at the Wooden Stuff centre, Thetford Forest for a picnic by the river and most recently to the Ipswich Regent dressed up as a Nun to take part in the interactive sing along show of The Sound of Music. The service user told the inspector “I am very happy living at the home, staff look after me, they are very kind”. Another service user said they had been to watch their team play at Ipswich Football Club. Service users are seen as full members of their community they attend day clubs, women’s clubs, a sports club on a Friday and the Chestnut club (day club). Service users travel to and from these activities using taxis , supported by home staff. Some residents have bus passes, but do not use them. Service users also spoke of concerts they had been to in the past. Service users were observed spending their leisure time engaged in activities of their choice, for example one-service users was seen relaxing in their room drawing and colouring. Another service user showed the inspector some lavender cushions they had made that day using their sewing machine. However, a relatives comment card raised concerns about weekends offering little outside activities due to staff shortages. They made suggestions, recommending service users could go for walk, which costs nothing and helps to fill the days. This was reiterated in the service users ‘Have your say’ cards with comments, “I would like to do more,” and “I would like to go out more”. This was discussed with the deputy who acknowledged weekends were more difficult, as there are only two staff on duty, with three allocated for Saturdays until 2pm in the afternoon, however rotas supplied with the pre inspection questionnaire reflects this is not always the case. The deputy confirmed that a volunteer was in the process of being police checked and is willing to help out with activities at weekends. Service users are able to maintain contact with friends and family. Many family photographs, postcards and letters around the home and in service users rooms confirmed this. A service user has regular contact with a befriender and told the inspector they had been out with them the previous day shopping. Service users are able to make and receive personal calls, with freedom to go somewhere private to talk and that they are free to visit family when they want, for example at Christmas and birthdays. One service user explained they were going out with relatives for their birthday and that they were going for a drive in a limo and then for a meal. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 15 Comment cards confirmed that staff support service users daily routines as described in their support plans. Comments included, “I can’t wash my back or my hair so staff help me and make me look nice” and “Staff help me sort my clothes out and put my money in envelopes for the week and help me with my shopping list”. A roster on the fridge door showed that service users have responsibility for household chores with designated tasks to be undertaken each day. These included assisting with the preparation and cooking of meals and packed lunches, washing and drying up, laying the table, cleaning surfaces and emptying the dishwasher. A service user commented that, “I like to take part in the activities in the home, I do the hovering, prepare the vegetables for diner, empty the dish washer and help weed the garden”. During the evening meal the expert by experience was told by a service user with a visual impairment that “I choose my food and record it onto tape” so that I know what I have requested. Service users confirmed they could choose what to eat and when throughout the day including snacks and what they wanted to have for dinner. Each service user picks a dish each day (1stservice user Monday, 2nd Tuesday etc.) with a roast dinner cooked on a Sunday. Service users confirmed, “If I don’t like what is for diner I can choose something else I like.” Evidence was seen that staff adhered to good hygiene standards and food was being correctly stored in the fridges and freezers. All food was covered and dated and temperatures were being recorded. Magnetic pictures of food and the picture of the service user whose choice of menu it is for the day are displayed on the fridge, which reflected service users were receiving a varied and balanced diet. Three of the service users monitor their weight and the menus reflected a lighter option to the chosen meal. Two large white magnetic boards have been purchased and put up in the dining room for information, including the menu choices and photographs of staff on duty. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, Quality in this outcome area is good. People living in the home can expect to be protected by the homes medication procedures and have their health and emotional needs met in partnership with professional specialist support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Support plans identified the health and personal care needs of the service users and their preferences of how and when they required staff support. Service users informed the expert by experience that they could choose to have a bath or shower when they wanted. Daily records confirmed service users were being supported to access health professionals when required and their health needs were being monitored. An ongoing record of dates for health visits is kept including visits made to or by the General Practitioner (GP) and the details of care and medication prescribed. There were also records of appointments with other professionals such as dentist, hospital consultants, chiropodist and optician. A service user’s comment card stated, “Staff came to the hospital with me when I hurt my big toe” A service user informed the expert by experience that the GP visits the home when I am ill. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 17 Where required service users are referred to relevant specialists. A dementia nurse from the Alzheimer’s society has visited the home in conjunction with a Psychiatrist to assess the environment and care needs of one of the service users. They have confirmed protocols and daily routines, which will enhance the service user’s quality of life. The dementia nurse has provided training to ensure staff have the knowledge and skills to meet the service users changing needs. The Learning disability and Community Mental Health Team have also been involved helping to support service users at the home. The National Health Service (NHS), Practitioners Services Unit, conducted an audit of the homes medication in March 2006. Their audit confirmed there are no controlled drugs held at the home. The auditor supplied a list of dates for the return of unopened medicines. The returns book confirmed staff were operating with in these guidelines. Service users medication is kept in the staff office in a locked cupboard. Staff administer medication to the service users and evidence was seen that the Medication Administration Records (MAR) charts were being signed appropriately and those seen were accurate and up to date. The deputy was advised that a photograph and brief information about the service user, for example name, date of birth, allergies and name of GP should be implemented for identification purposes. A weekly check of medication is undertaken every weekend. Staff responsible for administering medication have received appropriate care of medicines training. The home has a homely remedies protocol, which informs staff to contact the GP before administering these medicines, and that records must be kept of any medicines administered. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 18 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. Service users and their relatives can expect their concerns to be listened to and complaints investigated. However outcomes of investigations into day-to-day service user issues need to be recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are issued with an audiotape of the complaints procedure, called ‘Helping us to get it right’, however three residents ‘Have your say’ comment cards noted they were not sure how or who to complain too. This was discussed with the deputy who acknowledged this was an issue that would be discussed at the next residents meeting. The home has received one complaint since the last inspection in February 2006. This was investigated by the area manager, who upheld the complaint regarding a member of staff in breach of confidentiality. The outcome was feedback to the complainant who appeared to be satisfied with the outcome. The home does not have official complaints log although the deputy produced a book of ‘issues’, which document day-to-day concerns, raised by service users. An entry reflected a service user was unhappy that another service user had received their medication before them in the morning. The deputy described the situation and how this had been overcome; however no outcome had been recorded of how this issue had been resolved. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 19 The organisation’s policy and procedure are very clear and detailed of staff’s responsibility to report allegations or suspicions of abuse to the Local Authority Vulnerable Adult Protection Committee (VAPC) and informing the Commission for Social Care Inspection (CSCI). To ensure service users are protected from abuse, neglect and self-harm, all staff have a Protection of Vulnerable Adults (POVA) first and Criminal Records Bureau (CRB) check undertaken prior to taking up a post. Staff spoken with confirmed they were aware of the Whistle blowing and Adult Protection procedure. They confirmed they would report any concerns about improper conduct of their colleagues towards a service user to the manager. Training records showed that all staff have received updated training the protection of vulnerable adults Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 20 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): 24,26,27,28,29,30, Quality in this outcome area is good. The home provides an environment, which is well maintained, pleasantly decorated and is appropriate to the specific needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cumberland Road is situated in a quiet road and is in keeping with the other houses. It consists of six bedrooms with a large open plan communal living area comprising of dining area, lounge and kitchen leading through into a conservatory. There is a separate utility room. All corridors are wide to facilitate a wheelchair user living in the home. There are five bedrooms on the first floor and one on the ground floor with wheelchair access with an en-suite bathroom. The bedrooms are fitted with wardrobes, a lockable cupboard and a washbasin. The home is kept clean, warm and tidy and has no unpleasant odours. All areas of the home are nicely decorated, in bright and cheery colours. Furnishings and fittings were seen to be of good quality and domestic in nature adding to a comfortable and homely environment. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 21 The expert by experience observed that each service user has their own room and that they could choose the colour and décor in their rooms. There are a lot of service users photographs in the hallways; each service user had their own frame, which they decorated with shells they had collected following a day trip to the beach. Service users were observed being consulted on how to re-decorate the kitchen and dining room, regarding colour and décor. A service user commented, “I like my room and the table and chairs provided so I can sit outside, if I want to listen to music I like to sit in the conservatory”. The conservatory overlooks the gardens, which have raised beds, ornaments and bird tables. Christmas decorations were seen in the conservatory service users and staff were in the process of putting them up. There was also a set of pigeonholes with service users names carved out of wood, which contained their individual post. A stair lift is provided for service users that cannot use the stairs to access the upper floor. This was serviced in January and July this year and is in good working order. A service user has their own mobile hoist in their room this had been serviced in April 2006 and was due to be serviced the following day. The deputy manager informed the inspector that arrangements were in process for an overhead-tracking hoist to be installed in the service users room. One service user has an en-suite bathroom, which contained a shower bed, which raises and lowers. It has a covered waterproof mattress and bumpers for the comfort of the service user. The overall décor and maintenance in the home is good. However the wall where a mirror has been removed in the downstairs toilet and replaced with a paper towel dispenser needs to be repainted. Water temperatures are being recorded and there was evidence to show these were tested and found to be within the safe recommended temperature of near to 43 degrees centigrade. A good supply of plastic aprons, disposable gloves, liquid hand soap and paper towels were available in all bathrooms and toilets. The laundry room was clean and tidy. A disposal of body waste procedure was displayed in the laundry, which guided staff to put clinical waste into the yellow bags provided. These were collected weekly. All soiled clothing and bedding is put through the sluice cycle in the washing machine. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 22 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): 32,33,34,35,36, Quality in this outcome area is good. Service users can expect to be supported by a staff team that are trained and have the skills and knowledge to care for them, however cannot expect staff are available in sufficient numbers to meet their social needs at weekends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The expert by experience established that ten carers work at the home. Two work during the day and one stays overnight. Sleep in staff stay in the upstairs room that doubles as a staff office. The home employees all female staff at present, but this has not always been the case. Staff have a good relationship with residents, they are very approachable and friendly. The staff roster confirmed there is two staff on duty when the service users are at home. All service users receive direct payments, which cover the cost of their day care. As discussed in the lifestyle section of this report, weekends have two staff on duty, with a third allocated for Saturdays until 2pm. This was discussed with the deputy manager who acknowledged that providing activities for all the service users at weekends is difficult. They try to make sure that each service user attends outside activities on a rota basis. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 23 A volunteer is in the process of being recruited. However volunteers should not be relied on to supplement staff roles and staffing levels need to be reviewed regularly to ensure there is sufficient staff available at peak times to reflect the needs of the service users. The minutes of a staff meeting held in November reflect that regular monthly staff meetings are taking place. The meeting included a training session provided by the Alzheimer’s society. General issues about medication and fire safety were discussed and that staff were to continue taking photographs of meals to build up a collection to provide a menu for the whiteboard. The deputy manager informed the inspector they had recently started to discuss the National Minimum Standards (NMS) at staff meetings. Section 1, Choice of home had been discussed and the reason for the changes to the statement of purpose to reflect the category of service users living in the home. The next section is to be discussed at the next meeting scheduled for 15th December. The agenda was pinned to the staff notice board and staff had entered items for discussion on the agenda. All staff have attended core training throughout the year which included moving and handling, fire safety and prevention, health and safety, first aid, safe food handling and risk of abuse in the care home. Other training consisted of person centred planning and dementia awareness. Staff files showed that staff had completed or were undertaking National Vocational Qualification (NVQ) at either level 2 or 3. Staff files seen confirmed the home is obtaining all the appropriate paper work including police and Protection of Vulnerable Adults (POVA) checks. A letter was seen on one staff file confirming clearance of their Criminal Record Bureau (CRB) check, however the deputy confirmed that the original had been destroyed. They were advised that the original should be kept until an inspector from the Commission for Social Care Inspection has seen it and a record of the date and signature of person destroying the document is kept. The application forms of two employees had not been fully completed. There was no record of continuous employment history; in the case of a new member of staff there was an unexplained ten-year gap between jobs. This was discussed with the deputy manager and needs to be explored and outcomes recorded to assess the fitness of the employees to work with vulnerable people. A new member of staff was on duty and talked to the inspector of their experience working at the home. They confirmed they had worked alongside experienced staff for a number of shifts and today was their second designated shift. They confirmed they were scheduled to start their induction training beginning with moving and handling the following week. Generally they felt they were getting on well with the service users, getting to know them and felt supported by the manager and other staff. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 24 Another member of staff spoken with commented this was their first job in care and they too felt supported by the management team and their colleagues. Induction of new staff was being undertaken in line with Skills for care, through Loughton College and supported by Mencap’s own training programme. Staff spoken with told the inspector that they receive regular supervision, however, records show that supervision of staff does not meet the recommended minimum of six sessions per year. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 25 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): 37,38,39,42,43, Quality in this outcome area is good. Service users can except to live in a home that is effectively managed and protects their health, safety and welfare, but does not currently seek the views of service users and other people associated with the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cumberland Avenue has a manager and a deputy manager. The manager was at a meeting and unavailable for the inspection. The deputy manager should have been on a day off but made arrangements to meet with the inspector. The deputy manager has a wealth of experience working with people with learning disabilities and has worked at the home since 1997. They have a degree in economics and are considering undertaking a National Vocational Qualification (NVQ) at management level. They demonstrated a good knowledge of the service users and staff. Staff and service users spoken with found the management team were approachable and supportive. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 26 Mencap have devised a continuous improvement plan which staff are to use to provide information on what the home needs to do to improve, how this will be achieved, how areas of improvement were identified, who needs to be involved and when and what can be done to make things better. The deputy confirmed that this had not been a huge success and issues continue to be discussed at the staff meetings. However a quality assurance and monitoring system should be undertaken at least annually, which seeks feedback about the service from service users, relatives and other people connected with the home. A copy of the report must be made available to service users, and staff and a copy sent to the Commission for Social Care Inspection (CSCI) to reflect how information is used to improve the service. The fire logbook was seen which confirmed that safe working practices were in place. A fire safety risk assessment had been completed and updated in June 2006. Weekly fire alarm, emergency lighting and visual fire fighting equipment checks are taking place. A problem had been detected through these checks that fire doors were not fully sealed when closed, this issue was raised with Suffolk Housing who have been liaising with the company that installed the doors to resolve the issue. The fire alarms system and emergency lighting were serviced in October 2006 and the annual service if the fire fighting equipment was undertaken in August 2006. The fire and rescue service completed an audit of the home in June 2006. No concerns were raised. The gas safety record and certificate was seen and a service in January 2006 confirmed all was satisfactory. Portable Appliances had been tested and a certificate issued in June 2006. The accident book was seen, this is used for service users and staff and there had only been two entries during 2006. These were minor accidents involving service users one was a fall and the other being hit in the eye by shrubbery whilst gardening. No injuries were sustained. The deputy manager showed the inspector the home’s income and expenditure accounts for the period up to September 2006. These figures reflected that the home is on target to meet the budget forecast and that the home is financially viable. Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 2 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 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 3 3 Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 28 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 YA5 Regulation 5 (c) Requirement The registered manager must ensure that the terms and conditions laid out in the licence agreement are reviewed and amended annually to reflect the current fees. The registered manager must ensure care plans have established individualised procedures, which have been discussed and agreed with the service user for dealing with incidents of inappropriate behaviour. These procedures must be recorded in a plan with clear guidelines as to what actions staff should take in each circumstance to protect the rights and best interests of the service user The registered manager must establish and maintain system for consultation with service users and their representatives. The registered manager must regularly review staffing levels to ensure there is sufficient staff at peak times to reflect the needs of the service users. Timescale for action 31/01/07 2. YA6 15 31/01/07 3. YA8 24 (1)(3) 31/01/07 4. YA33 18 (a) 31/01/07 Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 29 5. YA34 Sch 4 (6) (f) 6. YA39 24 The registered persons must 31/01/07 ensure that any gaps in employment records are explored prior to the appointment of staff. The registered manager must 30/03/07 ensure there is a quality assurance system introduced and undertaken at least annually which seeks feedback about the service from service users, relatives and other people connected with the home. A copy of the report must be made available to service users, and staff and a copy sent to the Commission for Social Care Inspection (CSCI) to reflect how information is used to improve the service. 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 YA20 Good Practice Recommendations The registered manager should implement an identification page to placed at the front of each service users MAR chart which has a photograph and contains brief information about the service user, for example name, date of birth; allergies and name of GP. The registered manger should record the outcomes where issues raised by service users are investigated and resolved. The registered manger should keep original Criminal Record Bureau (CRB) checks until seen by an inspector from the Commission for Social Care Inspection. A record should then be made of the date and signature of person destroying the document. The registered manager should take steps to ensure that supervision of staff meets the recommended minimum of six sessions per year. 2. 3. YA22 YA34 4. YA36 Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Cumberland Avenue Residential Home DS0000024369.V325036.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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