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Inspection on 17/06/05 for Duchy Avenue (13)

Also see our care home review for Duchy Avenue (13) for more information

This inspection was carried out on 17th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager makes sure that the policies and procedures are followed by staff to make sure service users are safe. Staff are trained especially to look after people with learning disabilities. Managers and staff work hard to make sure that the people who live in the home have everything they need and are treated with dignity and respect.

What has improved since the last inspection?

Some redecoration and repairs have been made to the home. All staff have either completed or are due to complete NVQ training.

What the care home could do better:

No areas for improvement were identified during this inspection.

CARE HOME ADULTS 18-65 Duchy Avenue (13) 13 Duchy Avenue Harrogate North Yorkshire HG2 0NB Lead Inspector Chris Taylor Unannounced 17 June 2005 10:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Duchy Avenue (13) Address 13 Duchy Avenue Harrogate North Yorkshire HG2 0NB 01423 528208 01423 528208 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Northern Life Care Limited t/a U.B.U. Mrs Jean Annette Baross Care home only 4 Category(ies) of LD Learning disability (4) registration, with number of places Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24.02.05 Brief Description of the Service: 13 Duchy Avenue is registered to provide accomodation and personel care to four adults with learning disabilites. The house is a three storey large victorian terrace and is located close to Harrogate town centre. The home is owned by UBU formally Northern Life Care. Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. There were no service users at home and the staff team had gathered to complete fire safety training provided by a specialist trainer. Records and discussion with the manager and staff took place about health and safety in the home, how many staff are on duty, how service users are protected from abuse, the ways service users can tell the home what they think about it and a check of some re decoration work that was needed. The inspection took 3 hours including preparation time. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none EVIDENCE: Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none EVIDENCE: Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none EVIDENCE: Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 10 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none EVIDENCE: Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 11 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Service users are safeguarded from abuse. EVIDENCE: The Adult Protection Policy is supported by a Whistle Blowing Policy and staff disciplinary procedures. UBU provided specific training in adult protection and anti oppressive practice and it is also included in induction and NVQ training. Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 12 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 Service users live in a home that is clean comfortable and well maintained. EVIDENCE: The previous inspection made requirements about some repairs which were needed. The damaged worktops and kitchen units have been repaired. Due to torn wallpaper in the hall, stairs and landing complete redecoration has been costed and is due to take place soon. A new window has been installed to rectify the draft from the window on the first floor front bedroom. The house was clean and furnished to a high standard. There is a comfortable lounge and large kitchen diner which tends to be the hub of activity. There are sufficient bathrooms and toilets. Bedrooms were not looked at because service users were not at home. Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 13 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Service users receive care and support from a well trained staff team. EVIDENCE: The staff team at Duchy Avenue is small and well established. The numbers of staff on duty is appropriate and safe enough for the service users who live there. Service users are fairly independent and would find higher numbers of staff too intrusive. All staff have completed or are completing NVQ level’s 2 and 3. UBU have a training and development programme which is compiled as a result of staff appraisals and quality assurance. It includes statutory health and safety training and more specific training relating to the needs of service users. Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 14 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 Service users views are included in reviewing the quality of the service provided. The health and safety of service users is safeguarded. EVIDENCE: The home has a formal quality assurance system called Continuous Quality Improvements. This includes details about improvements to be made over a 12-month period and progress is monitored closely. Identified areas for action include staff training, environment and service users targeted ambitions. Previously the main source of input was from the staff team however, questionnaires for service users have recently been developed and these will form part of quality assurance. The format of these questionnaires includes pictorial prompts. Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 15 Records were seen which confirmed that equipment is maintained; gas and electricity supplies in the home are safe and serviced appropriately. Fire detection and fire fighting equipment is tested and maintained regularly. Staff receive training with regard to all health and safety matters and staff said there is a good system to make sure they complete regular up dates. Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Duchy Avenue (13) Score x x x x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 17 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Unit 4, Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Duchy Avenue (13) v232807 j53-j04 s7882 duchy avenue (13) v232807 270605 stage 4.doc Version 1.30 Page 19 - 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!