Inspection on 30/05/07 for Denewell Avenue (17)

This inspection was carried out on 30th May 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Denewell Avenue (17) 17/11/05

Denewell Avenue (17) 09/02/05

Denewell Avenue (17) 02/08/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Denewell Avenue (17) Low Fell Gateshead Tyne & Wear NE9 5HD Lead Inspector Miss Nic Shaw Key Unannounced Inspection 30th May 2007 10:00 Denewell Avenue (17) DS0000007385.V336078.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 Denewell Avenue (17) DS0000007385.V336078.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. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Denewell Avenue (17) Address Low Fell Gateshead Tyne & Wear NE9 5HD 0191 487 5068 OUT OF ORDER ntawnt.denewell@nhs.net 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) Northumberland, Tyne & Wear NHS Trust Heather Ross (not yet registered) Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2005 Brief Description of the Service: 17 Denewell Avenue is owned and managed by Northgate and Prudhoe NHS Trust, The Trust. It provides ordinary housing for people who have a learning disability. Denewell Avenue can provide personal care for three adults. The service cannot provide nursing care. The home is a four bedroomed semi detached house and offers single bedroom accommodation, a lounge, dining room and kitchen/diner. All bedrooms are located on the first floor and as there is no lift, the home would not be suitable to people who have a physical disability. There is a lawned garden and patio to the rear and a smaller garden to the front of the home. The home is situated in the Low Fell area of Gateshead near to local amenities and facilities including shops, public houses, and places of worship. There are bus stops nearby which link with the main regional centres and the home has its own transport. The gross weekly cost of the service is £1051.68. The weekly fee payable by service users is £62.35. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit took place over one day and was an unannounced key inspection. During the visit time was spent talking to the manager and staff. The service users were present throughout. Some time was spent looking at the home, including the lounge, dining room, service users bedrooms and the garden. A sample of records were also looked at. The inspection included information which had been provided by the manager in a questionnaire. Questionnaires were also sent to each of the service users relatives. All three relatives completed and returned a questionnaire to the Commission before the inspection. The inspection focused on all three of the service users, all of whom have very different needs. This is known as “casetracking”, and this involved looking at what it was like, from their point of view, living at Denewelll Avenue. Time was spent chatting with the service users as well as watching the staff’s care practices with them and making sure that the support that was given was accurately recorded in the care plans. What the service does well: The service users needs are regularly re-assessed so that everyone knows that Denewell Avenue continues to be the right place for them to live. Care plans and risk assessments are good. The manager and the keyworker are currently looking these to make sure the information recorded is kept upto-date. In order to help the people living at Denewell Avenue to make choices and decisions there is lots of information in their care plans about how they communicate. The food is nice and service users can take part in a number of leisure and community activities. The home has its own transport and the staff make sure that each year everyone has a holiday. If a service user is unwell the staff make sure they get to see their GP quickly and the staff always arrange for service users to attend other health care appointments regularly. Relatives said they knew how to complain and when they do complain this is looked into quickly by the manager. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 6 The staff have had lots of training, such as person centred planning, so they can do their job well. They have also had training so they know what to do to stop people from being abused. There are good quality assurance systems in place, such as regular checks of the medicines, and this helps to make sure that standards of care are maintained. 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. Denewell Avenue (17) DS0000007385.V336078.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 Denewell Avenue (17) DS0000007385.V336078.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 good. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs are always assessed prior to admission in order to determine that these can be met in the home. EVIDENCE: Although there have been no new admissions to the service since the home first opened some years ago, there are clear admission policy and procedures in place. These include obtaining an up-to-date care management assessment so that future prospective service users are assured that the service will be able to meet their needs. Recently the needs of all three service users have been re-assessed by a social worker to make sure that their needs continue to be met at Denewell Avenue. An advocate has been involved in this process. Denewell Avenue (17) DS0000007385.V336078.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 good. This judgement has been made using available evidence including a visit to this service. The care plans are good and give specific information about service users as individuals, which helps to provide a good quality of care. Service users are able to take risks and the staff continue to develop ways of communicating with the service users in order to help them make choices in their daily lives. This enables the service users to lead independent lifestyles. EVIDENCE: Care plans provide staff with clear guidance on the action they need to take to meet each service user’s assessed needs. The plans are person centred and focus upon the individual’s strengths and personal preferences. They are written in such a way as to ensure that service users are given as much control as possible over the activities of daily living. For example: for one service user Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 10 this means they are able to enjoy a soak in the bath without being supervised by staff. The keyworkers complete a monthly evaluation, a copy of which they send to the service users relatives. The care plans include pictures and are written in plain English so that they are easy for people to understand. Good information on the service user’s method of communication is included in a “communication dictionary”. Service users are encouraged to be independent in all areas of their daily life, such as personal care and taking part in activities inside and outside the home. All of these activities can involve taking a degree of risk. The manager assesses any hazards that may be involved in carrying out certain tasks, as well as identifying any benefits and pitfalls. If hazards are too great, choices may be restricted to promote safety for that person. Information about risks are recorded in the format of a risk assessment; this allows staff to give the correct amount of support to the person as well as reducing any further chances of hazard. Examples of risk assessments in place include making a cup of coffee, carrying hot drinks, and having a bath independently. Denewell Avenue (17) DS0000007385.V336078.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 good. This judgement has been made using available evidence including a visit to this service. Service users are supported to take part in a range of activities both inside and outside the home. Service users are assisted to maintain links with their families and to have a regular community presence. This will assist them to lead a full and enjoyable life. Service users are provided with a nutritious, varied diet which helps to promote their general health and well being. EVIDENCE: There is an activities timetable which shows what each service user will be doing each day. The manager is currently reviewing the number and range of activities being offered to each service user. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 12 Usually, during the week, service users attend day centres, however, on the day of the inspection the day centres were closed and everyone was at home. There were only two staff on duty and therefore on this particular day there were limited opportunities for service users to take part in leisure or community activities. However, at other times additional staff are provided so people can enjoy activities of their choice. Regular activities include a weekly disco, which everyone likes to attend, shopping at the Metro Centre, going to concerts, and one service user has recently begun to attend a local Church. All of the service users will experience a holiday this year. These have been arranged based upon the staff and their knowledge of each service user’s personal preferences. One service user has recently been able to fulfil their dream of travelling by aeroplane. Although none of the relatives were visiting on the day of the inspection information received from them confirmed that they are able to visit their family member at any time and are always made to feel welcome by the staff. Service users are able to spend time on their own or with others and there is plenty of space available in the house to facilitate this. Individuals’s preferred daily routine is recorded in their care plans. Menus are planned and decided based upon the service users likes and dislikes, which is recorded in their care plans. Mealtimes are very flexible and times of meals depend on the routines and activities that service users are attending. Service users are encouraged and supported by staff to prepare their own meals. The Inspector sat and chatted with service users and staff over lunch, which was a relaxed social occasion. Denewell Avenue (17) DS0000007385.V336078.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 good. This judgement has been made using available evidence including a visit to this service. Service users receive the support they need from staff to ensure that their personal, physical and emotional health needs are met. Although generally medication policies and procedures are good some improvements need to be made in this area to fully protect the service users. EVIDENCE: The care plans provide clear guidance to staff on the service users preferences on how their personal care needs are to be met. The areas covered within the care plans include bathing, mobility and continence needs. The care plans are all different and the content reflects the personal care needs of each service user. Service users are encouraged and supported to remain as independent as possible in the area of personal care and this was reflected in the care plans. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 14 Service users have regular access to their GP and other medical professionals such as chiropodists, opticians, dentists, community nurses, speech therapists and consultant psychiatrists. Where it has been identified as a need detailed behavioural guidelines have been developed. These provide good information to staff on those situations which may cause a service user agitation as well as what action they should take to appropriately support the service user when this happens. Medication records examined confirmed that medication is generally administered to service users appropriately. However, there has been one occasion where a service user has not been administered their prescribed medication. Staff sought appropriate medical advice at the time of the incident and procedures are in place to prevent this from happening again. Systems are in place for ordering and the safe disposal of medication. An audit of the medication held in the home was checked and correct and corresponded to the medication administration record. However, an “as and when” prescribed oral medication and cream for one person had not been recorded on the Medication Administration Record. Medicines are stored safely and securely and follow the Royal Pharmaceutical guidelines. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. 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. Arrangements are in place through the complaints process to promote the service users safety and offer protection. Appropriate policies and procedures are in place, supported by staff training, which ensure that service users are protected from abuse and neglect. EVIDENCE: There is a complaints procedure available to the service users in plain language and large print. Relatives said in the questionnaires received that they knew how to make a complaint. There has been one complaint since the last inspection. Although the manager has handled this appropriately and the outcome used to improve the service a record of this had not been maintained, which is requirement. Staff said that they had had training in relation to the protection of vulnerable adults. There is also written information available to staff, called “don’t delay” advising them of their duty of care to report bad practise or any suspicion of abuse. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24&30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is homely, comfortable and clean providing the service users with a safe place to live. However, some of the communal areas and service user’s bedrooms need to be re-decorated in order to provide a well maintained environment for the service users. EVIDENCE: The building throughout was found to be clean with no unpleasant odours. There is a communal lounge and separate dining room that leads onto a well maintained enclosed garden area. These are bright, airy comfortable places in which the service users can engage in activities of their choice. Although there is a maintenance programme, which involves the manager submitting an annual request to the maintenance Department within the Trust, she does not have direct control of a budget to address issues as required. As Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 17 such there tends to be a slippage of timescales. There were a number of areas within the home that require attention, for example: the paintwork in the corridor, landing and kitchen area all need attention, the bathroom suite does not match, the toilet and sink are beige in colour whilst the bath is white. Although a new stair carpet has been purchased this does not extend to the hall area, which is now a contrasting colour. In one service user’s bedroom the fitted wardrobes have been removed, however, this area has not yet been redecorated. Service users said they liked their bedrooms. Detailed policies and procedures are available in relation to infection control and discussion with the manager and staff confirmed that they have all had training in relation to this as part of their induction training. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34&35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well trained staff team and staffing levels are adequate, although sometimes there may not be enough staff on duty to fully address the service users social and leisure needs. There has been a large turnover in staff, which does not provide continuity of care for the service users. Staff records are not held within the home and as such it was not possible to confirm that the service users are supported and protected by the home’s recruitment practices. EVIDENCE: There are always two staff on duty and an additional third member of staff is provided at specific times to ensure that the social needs of the service users are fully addressed. There is also always one nightshift on duty. However, on the day of the inspection, as the day centres were closed, all three service Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 19 users were at home. Additional staff had not been provided. Due to the complex needs of the service users, one of whom needs the support of two staff when going out, opportunities to take part in leisure activities at such times is very limited. Four out of nine staff have left the home since the last inspection. The Trust provides staff with opportunities to go on a wide range of training. In addition to mandatory training such as food hygiene and fire safety this has included training in specialist topics such as person centred planning and “conflict and resolution”. The manager has recently completed a training needs analysis which has helped her to identify where there are gaps in training. There is a training programme in place to address these gaps. There are only three of the nine staff left to complete the NVQ level 2 training in care. Staff said that they had been provided with induction training. Staff recruitment records are kept centrally so were not seen. However, the manager assured the inspector that the personnel staff make sure that CRB checks are completed, references obtained and full employment histories taken as part of the recruitment process. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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. Overall management systems are generally good and ensure that the health, safety and welfare of service users are promoted. EVIDENCE: Since the last inspection there has been a change in manager and deputy manager. The current manager has a number of years experience of managing services and is competent to run the home. She works to improve the service and provide a good quality of life for the service users, fully involving the staff in this process. An example of this is the involvement of staff in reviewing and up-dating the care plans. Staff said that they felt well supported by the manager. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 21 There have been no preventable accidents and appropriate records of accidents are maintained. The Trust has a comprehensive internal quality assurance system in place. This involves a monthly audit of a range of standards, including financial transactions and complaints. The home’s line manager also completes a monthly audit and this information is used to produce an annual development plan. The views of service users and their relatives are also sought through questionnaires and this information used to inform this process. There is a fire risk assessment for the building, however, this needs to be updated to reflect the current staffing levels during the night. During the inspection there were no health and safety risks noted. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 X 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 x Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement All prescribed medication must be recorded on the Medication Administration Record so that staff know when this should be administered. A record of all complaints must be maintained as this shows how the manager responds and deals with complaints and whether or not people are satisfied with the outcome. Timescale for action 31/07/07 2. YA22 17(2) 31/07/07 3. YA24 23(2)(d) 4. YA33 18(1)(a) 5. YA42 23(4) A programme of re-decoration 30/09/07 must be implemented without further delay so that service users live in a well maintained environment. Staffing levels must be kept 30/09/07 under review. This is to ensure that the leisure and social needs of the service users can be addressed at all times. The fire risk assessment must be 31/07/07 reviewed and amended to ensure the health and safety of the staff and service users. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 24 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 YA33 Good Practice Recommendations Steps must be taken by to ensure a low turnover of staff so that service users benefit from continuity of care. Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Denewell Avenue (17) DS0000007385.V336078.R02.S.doc Version 5.2 Page 26 - 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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