Inspection on 10/09/07 for Durham Avenue

This inspection was carried out on 10th September 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Durham Avenue 29/06/06

Durham Avenue 24/01/06

Durham Avenue 06/09/05

Durham Avenue 08/03/05

Durham Avenue 25/11/04

Durham Avenue 03/03/04

Similar services:

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Clover House

Parkside

Park Lodge

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

CARE HOME ADULTS 18-65 13 Durham Avenue 13 Durham Avenue St Annes On Sea Lancashire FY8 2BD Lead Inspector Denise Upton Unannounced Inspection 10th September 2007 1:15 13 Durham Avenue DS0000010073.V346511.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 13 Durham Avenue DS0000010073.V346511.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. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 13 Durham Avenue Address 13 Durham Avenue St Annes On Sea Lancashire FY8 2BD 01253 640880 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) Mr David Calwell vacant post Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th June 2006 Brief Description of the Service: Durham Avenue Care Home is currently registered to accommodate up to three adults who have a learning disability. The home is located in a quiet residential area of St Annes but within easy reach of the main shopping centre of the town, community facilities and resources. Communal areas of the home are domestic in character and each resident is accommodated in single bedroom accommodation. Residents access and enjoy local community facilities and are an accepted part of their community. The staff group ensure there is a homely and comfortable atmosphere in the home and that residents are enabled and empowered to maintain and maximise their independence as far as possible. The present rate of charges, (depending on individual needs) range from £673:00 to £1,368.00 per week. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, took place during a site visit to the home and looked at all the key National Minimum Standards, Care Homes for Adults (18-65) plus supervision arrangements for staff. An assessment also took place with regard to the progress of requirements made at the last inspection. At the time of the inspection there were three people in residence. The inspector spoke with the manager, two support workers and the three residents living at the home. Conversation with the three residents was however limited to general topics. Brief conversation also took place with a number of other residents living at the sister home who visited Durham Avenue on their way to a social activity. Records were viewed and a tour of the building took place. Information was also gained from Annual Quality Assurance Assessment (AQAA) completed by the manager prior to the visit. The total key inspection process focused on outcomes for people living at the home and involved gathering information about the service from a range of sources over a period of time. All the information gained helped to form an opinion as to whether Durham Avenue Care Home was meeting the individual wishes, needs and requirements of the people living there. What the service does well: There is a very good relationship between staff and resident’s that helps people living at the home to feel comfortable. Staff have good communication skills and know the needs, wants and wishes of each individual resident very well. The staff supervision and appraisal system is very good. This helps to guide staff in providing a high quality service. All staff are provided with a variety of mandatory training including healthy and safety training and also training specific to the needs of people living at Durham Road Care Home. Routines are flexible so that residents can, with support and guidance, choose the lifestyle of their choice. This is achieved by ensuring adequate staffing levels to enable residents to pursue their chosen individual activities. Durham Avenue Care Home has a good complaint policy that is easy for residents to understand as well as other policies that helps to protect residents from risks or harm. The atmosphere in the home is very relaxed and visitors are made welcome at any time of the resident’s choice. Residents are encouraged to have their say 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 6 and are involved in making decisions about how they would like the home to be run. Staff continue to maintain a high standard of support to those living at the home, which is a credit to the team. What has improved since the last inspection? What they could do better: The staff at Durham Avenue Care Home work well together to make sure that the needs of residents living at the home are met and that people feel comfortable living there. However a number of improvements could be made. Currently the registered homeowner/manager in not undertaking full time dayto-day management responsibility at the home, a new manager has been appointed. There is a requirement that in these circumstances, the new manager must be registered with the Commission for Social Care Inspection. Although the new manager has been working at the home for many months, no application has been received to register this person. This must be addressed. The report has stated that an application must be received by the end of the year. The registered homeowner/manager must also write a monthly report with regard to how the home is operating, but to date this has not been happening. This again is a requirement and must be addressed. Although staff training is seen as essential and residents are provided with a high quality of care, the number of staff with an NVQ qualification should be increased to at least 50 of the staff team. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 7 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. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 8 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 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 9 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. A well-established and detailed pre admission assessment process is in place to ensure that individual needs and requirements could be met and the home could provide the service required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to Durham Avenue Care Home for some considerable period of time. However there is a structured system in place to ensure that people are only admitted to the home if their individual needs and requirements can be met. Information about the home is produced in an easy read format to help ensure that prospective residents receive as much information as possible to decide if they would like to live there. Social work assessments are obtained and the manager would carry out her own thorough assessment of the prospective resident’s current strengths and needs. Relatives are involved as appropriate to the individual. Compatibility is given a strong focus and introductory visits take place at a pace suitable to the individual concerned that includes overnight stays. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 10 The management team are looking at the possibility of providing information for residents and prospective residents in alternative formats for example Braille and picture DVD’s that could be adapted to suit the requirements of each individual. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 11 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. There is a clear and consistent care planning and risk assessment system in place to adequately provide staff with the information they need to meet resident’s individual needs. Residents are supported and encouraged to make appropriate decisions and take informed risks in their every day lives. This helps to empower residents be as independent as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the inspection, one resident was ‘case tracked’. This involved looking carefully at all the information that is kept by the home regarding the assistance, encouragement and support required to ensure that the individual can enjoy the lifestyle of their choice. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 12 Each resident has an individual plan of care that tells staff what the resident’s strengths and needs are and how the wants and wishes of each resident can be achieved. Residents are very much encouraged to have their say about what they want and are involved in developing their personal care plan within individual abilities. Each care plan contains detailed information regarding the support required for all aspects of day-to-day living. Care plans are regularly reviewed, at least every six months with more frequent reviews taking place soon after admission or when required. When there is sufficient understanding, care plans wherever possible, are signed or marked by the individual resident, or alternatively a relative as acknowledgement, once the contents has been agreed by them. Residents also have a detailed comprehensive health action plan covering a wide range of topics. Communication profiles are incorporated within individual health action plans to enable staff or other agencies to communicate and understand the individual’s needs and choices. This focus on communication helps to promote self-determination and supports individuals with decisionmaking. Staff have developed good relationships with residents and have a good understanding of the communication needs of each person. A number of staff have also attended a building blocks course run by a local training company that provided specialist training on communication. Two members of staff have recently attended health action plan training delivered by a community mental health nurse. This training focused on how to undertake a good health needs assessment and develop a health action plan. It is anticipated that all members of staff will eventually undertake this training. Residents are encouraged to make appropriate decisions and take risks that would enable them to be as independent as possible. The interaction observed between residents and staff and residents with other residents was very positive. It was clear that there is a mutual respect and friendship between all staff and residents. Staff provides guidance regarding safety, such as in the kitchen, as part of their day-to-day support worker role. Risk assessments are in place and are being regularly reviewed. It was noted that staff were taking into account the outcome of formal risk assessments when supporting residents in daily activity. One person in the home can display aggressive behaviour that sometimes requires limited restraint. Although there is an up to date care plan in place and staff spoken with were clearly aware of the circumstances of when it would be appropriate to use restraint, this was not clearly identified on the risk assessment. There was also no indication as to what form the restraint should take. It is important that the exact circumstances of when restraint may be 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 13 used and the form the restraint may take be clearly identified in the risk assessment to provide detailed and accurate information. All members of staff have received specific training with regard to managing behaviours that challenge. Information continues to be available regarding an independent advocacy service should a resident be in need of an impartial representative to advocate on their behalf. This helps to demonstrate that the provider is committed to ensuring that the choices, opinions and decisions of residents are listened to and acted upon appropriately. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 14 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. Activities are arranged according to people’s preferences and interests and family links are maintained. Meals take into account individual needs and preferences and provide a balanced and wholesome diet. This helps to promote a healthy eating plan for people living at the home. Residents help to undertake household jobs according to their wishes and abilities. This helps to promote a sense of achievement and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Education, occupation and personal development opportunities are addressed on an individual basis. One person enjoys attending a local resource centre weekly for dancing lessons. Another resident is supported and enabled to grow 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 15 flowers, plants and vegetables at the home, an activity that he clearly enjoyed and that also helps to support the healthy eating programme. Arts and crafts, music and art classes are also enjoyed by residents when attending the resource centre. During the course of the site visit, a support worker, working in the sister home, visited Durham Avenue with the residents from the sister home. They had called to pick up one of the residents living at Durham Avenue so they could all go out together to enjoy a collective social activity in the community. The residents and the staff confirmed that there is a strong link between the two homes and that people living at both homes often participate in leisure and recreational activities together, The support worker explained that often activities are arranged on an ad-hoc basis and very much arranged around what each individual resident wants to do at any particular time. This can include shopping, craftwork, jigsaws, cinema and music sessions. One resident wanted to spend more time with residents at the sister home so staff rotas were changed to enable him to spend at least one day a week going out with them. Residents have access to a car and there have been trips out to places of their choice. One resident particularly enjoys museums and another aeroplanes so trips out have been catered around individual interests. The resident who enjoys aeroplanes was also supported to enjoy a weekend away with a support worker staying in a hotel when he wanted to see an air show and air display that included a fly over by the Red Arrows. In the future it is hoped that some paid or voluntary work that would suit individual interests could be secured for people living at the home. It is also hoped to enrol for regular activities at a local college to enable one particular resident to have a more structured routine. Residents are part of the local community and staff confirmed that there are positive relationships with neighbours. The home is well situated for an easy walk to access a wide range to the towns’ facilities and services. Residents are enabled to vote at local and government elections and there was also evidence of residents having their own ‘last will and testament’, which further demonstrates that people are encouraged and supported to make important and valued decisions about their lives. Assessment and care planning information includes details of ‘important people’ individuals living at the home have close links with. Residents have regular contact with their family members and lists of friends/family birthdays and other special date’s is maintained. Staff support resident’s in buying cards and presents for birthdays/Christmas. Family’s are invited to birthday parties and at Christmas and all maintain a good relationship with each other’s family 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 16 and friends. Two residents have families that now live abroad, however residents are supported to maintain regular telephone contact with them and are supported to write letters when something different has happened such as a holiday. A member of staff also enabled and supported a resident when she went to stay with her sister in Spain for a few days. Whilst she was there the member of staff discussed and reviewed the health action plan and person centred plan with the resident’s sister, her views and opinions were then taken into account at the next planned review. Daily routines are flexible and vary according to individual plans and activities. Individuals are supported to take part in household tasks such as cooking and cleaning, according to their wishes and abilities. During the site visit, one resident confirmed that she regularly went out with a member of staff to do the weekly household shopping. The layout of the home and large kitchen dining room, mean that residents can choose to spend time alone or join in with household activities. Residents decide on a daily basis what they would like to eat and it could be that everybody chooses to eat something different. People living at the home are encouraged as far as possible to contribute to the preparation of meals and the clearing away afterwards. In order to promote healthy eating, residents have been encouraged to draw or cut out fruit and vegetables to compile a ‘five a day’ chart which helps them to choose healthier options when deciding on meals. One resident was recently diagnosed with diabetes. With support, she has now changed her eating habits, is aware of what she can eat, has lost weight appropriately and her diabetes is controlled by diet only. It was clearly evident that there was a good rapport between the staff on duty and individuals living at the home. It was also evident that respect, privacy and dignity are demonstrated within the home. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 17 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. Personal support is offered in such a way as to maximise resident’s lifestyle choices. The care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure resident’s medication needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The individual care plan of each resident provides good information regarding the support required with personal care. Each person has a key worker and files contain guidance regarding any specific personal care needs. The AQAA completed by the manager confirmed that all staff receive regular in-house training in respect, privacy and dignity. The staff group is well balanced to enable residents to make a choice of carer in terms of male, female, and age related preferences regarding personal care 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 18 support. Staff observed were clearly very sensitive to the mood and behaviour’s of people living at the home and aware of the action required in order to provide a consistent approach. Health care needs are addressed very well and files contain good information in this area, including multi agency health care assessments and health action plans that include well maintained important information. In respect of one person living at the home that has a specific medical condition, a weekly weight chart is maintained. There were daily communication handover sheets, which were informative and up to date, in order to assist the carers in meeting individual resident’s daily needs, requirements, wants and wishes. All staff have undertaken training regarding medication. Medication is safely stored in a locked metal box in a new locked secure cupboard. The medication administration sheets viewed were appropriately maintained. Medication risk assessments are in place and medication is formally audited on a weekly basis with outcomes recorded. Good records are kept of medication received in to the home or for disposal. The healthcare support is very good, with staff keeping good records, monitoring changes and liaising with other professionals to ensure that residents get the best possible health care provision. General Practitioners undertake regular medication reviews for all residents, in order to ensure any prescribed medication is appropriate and to safeguard, promote and maintain the optimum health of people living at the home. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 19 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. People who live at the home are able to raise concerns. Policies, good practice and staff training help to promote the protection of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaint or concern has been made in respect of Durham Avenue Care Home since the last inspection. The home’s complaint procedure is compliant with requirements and incorporated in the written information provided to newly admitted residents in an easy read format. The policy outlines the home’s commitment to investigating any complaint received and confirmed that the complainant would be informed of outcomes. There is a good relationship in place that supports residents to feel they are listened to and to ensure that they feel safe and secure in discussing any issue of concern. Residents are encouraged to voice any concerns and complaints immediately so that issues can be discussed and addressed. Residents spoken with were clear as to who they would speak with if they did have a complaint or concern. The home also has a robust policy and procedures in place for protecting residents from possible abuse. This topic also forms part of the mandatory training provided to all staff and is a frequent topic at team meetings and individual supervision. A variety of other policies are also in place to protect 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 20 people living at the home that include, whistle blowing, restraint, aggression, receipt of gifts and bullying. The robust and well established recruitment procedures and the regular checking of resident’s finances also help to protect people living at then home. The finance records for one individual were viewed and showed that staff keep a good account of all personal income and expenditure. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 21 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 good. The standard of the environment within this home has significantly improved and now provides residents with a safe, attractive and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a requirement was made regarding the physical environment of the home that was unattractive, in need of redecoration and did not always provide a safe environment for people to live. Since that time however, there has been financial investment to the physical environment of the home that now provides a much more welcoming, bright, homely and attractive environment. All resident’s bedroom have been redecorated and new carpets fitted. A new fitted kitchen has been installed and communal areas decorated throughout. A new shower and toilet have been fitted and a hole in the outdoor yard 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 22 repaired. Locks to the toilet and bathroom have been provided that staff can enter from the outside in an emergency and resident’s bedroom doors can be fitted with a lock. One resident has his own bedroom key, risk assessments are in place for those who don’t. A number of new windows have also been installed. One resident is accommodated in a small bedroom. This resident was offered and accepted a larger bedroom however when she took up residence in the larger bedroom she became distressed. This resulted in a return to the smaller bedroom. The resident confirmed that she was quite happy with this smaller private space. It was noted however that the central heating system did not extend to this smaller bedroom. The bedroom was provided with a freestanding electric form of heating. Whilst this may meet current needs and requirements, a formal risk assessment should be in place with regard to the safety of this piece of equipment including the trailing electrical cable and socket. It was also clear that one of the other bedrooms occupied by a resident was without any form of heating for the winter months. Consideration should be given to providing some form of heating in this bedroom for when the weather is cooler. Ideally this should by way of the central heating system being extended to the two bedrooms without this facility. However if this is not likely to take place in the near future or if the resident concerned refuses to have a radiator in his bedroom, some other form of heating should be considered that would not compromise safety. A variety of environmental risk assessments are in place that includes the kitchen area, laundry and bathroom. Durham Avenue provides a homely environment with a variety of photographs placed around the home, showing various activities, days out, parties and holidays that residents have enjoyed. Presents that residents receive as gifts are displayed throughout the home as well as knick-knacks that residents buy themselves. One resident is of a different faith that does not accept flowers in an indoor area. The other two residents enjoy having flowers in the home. In order to address the different diversity and religious needs, an agreement was reached between the people living at the home that fresh flowers would only be available in one room in the house. This decision has been respected, giving all residents an equal say while finding an acceptable solution that has taken into account individual requirements. Laundry facilities are appropriately sited and staff are aware of hygiene/infection control issues and have undertaken health and safety training. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is good. The arrangement for the induction of newly appointed staff is good with staff demonstrating a clear understanding of their roles. There is a robust structured recruitment process for the appointment of new staff that helps to protect people living at the home. Staff are provided with a variety of training to ensure that a good standard of care and support is provided. However the number of staff with a nationally recognised National Vocational Qualification (NVQ) in care should be increased. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The members of staff spoken with displayed good communication skills when talking with residents and demonstrated a clear understanding of their role. The staff team has remained fairly constant, with little recent change, meaning that staff get to know the people living at the home very well. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 24 Additional staff are on duty at busy times and staffing levels are increased when activities are scheduled to take place or a resident is escorted to hospital for an appointment. The manager explained that the staff group are very flexible and always make themselves available when required describing them as “brilliant, fantastic, all go above and beyond what they should do”. File recordings indicate that staff have built up and maintained good working relationships with other professionals. From discussion with the manager it is understood that all newly appointed staff undertake the Learning Disability Award Framework (LDAF) induction and foundation training programme to ensure they are provided with the basic skills and knowledge to provided a good service. At present there are eight support workers. Two members of staff have achieved an NVQ Level 2 in care and a further member of staff is currently undertaking this course of study. Two further members of staff have undertaken a different form of ‘Building Blocks’ training that is a three-month training course that is specific for people working in a learning disability field. Two further members of staff have also part completed this course of study. It is understood that this qualification, once accredited, can be used towards obtaining an NVQ Level 2. There is an expectation that at least 50 of care staff should have achieved at minimum an NVQ Level 2 or equivalent in care. It is recommended that consideration be given to ensuring as many staff as possible undertake this course of study. All staff receive mandatory training and where possible, further training in specialised areas. Additional training is arranged to address the individual needs of the people living at Durham Avenue and has recently included a ‘management of aggression’ course. This included simple breakaway techniques that helped to build staff skills and confidence when dealing with aggressive situations. Since the last inspection, one new member of staff had taken up employment at the home. The staff file of this person was observed and confirmed that the recruitment practices followed were in accordance with requirements and recommendations. Appropriate references and clearances had been obtained and deemed to be satisfactory before the new member of staff commenced employment at the home. As part of the recruitment process, all prospective employees spend time with residents in order to elicit their views and opinions as to their suitability, which is taken into account when offering the post. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 25 Staff members are recruited from different cultures and faiths and have different skills, knowledge and experience in order to meet resident’s individual needs. Information contained in the AQAA completed by the manager confirmed that the staff group is diverse with regard to age, gender and sexuality that helped to meet individual resident’s needs and requirements. In discussion with staff, there was an understanding and awareness of equality and diversity issues and how to provide an individualised service. There are good supervision arrangements in place for staff. Supervision contracts are now in place between staff and the manager and it is understood that the aims of supervision are regularly discussed at staff meetings. Individual supervision takes place approximately every eight weeks or more frequently if required and addresses various topics, including training requirements. Any actions required is also identified and recorded. As evidenced, all supervision is recorded and action plans completed. There is also a good appraisal system in place. An appraisal takes place at the end of the six-month probation period, and then annually. Appraisals include a self-appraisal and a self-development plan and also revisit the individual job description of the person concerned. . Monthly staff meetings also take place and minutes of these were viewed. The supervision and appraisal system currently in place is very good, meaning that staff are well supported and guided in their work. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 26 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. Good management and quality monitoring systems are in place. Staff training, policies and good practice promote the health and safety of those living and working at the home This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered homeowner/manager at Durham Avenue has many years of experience in the care and support of people with Learning Disabilities, with various relevant training courses having been completed. Since the last inspection the registered homeowner/manager has successfully completed the Registered Managers Award. This is a nationally recognised 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 27 qualification in care and management that all registered managers of care homes are expected to achieve. This is to help ensure that they have the necessary skills and knowledge to provide a good service. However since the last inspection a new manager has been appointed and the registered homeowner/manager is currently not working in the home or providing management cover on a full time basis. There is a requirement that if the registered homeowner in not undertaking full time day-to-day management of the home, a manager must be appointed who is registered with the Commission for Social Care Inspection. The person appointed as manager has been in post for approximately twelve months but the Commission has not received an application to assess this person’s suitability to manage a care home. It is essential that an application to register this person as manager be submitted to the Commission for Social Care Inspection as a matter of urgency. There is also a requirement that if the registered homeowner is not in full-time day-to-day management of the home, the homeowner must visit the home at least on a monthly basis and write a report as to the conduct of the home. Whilst it is understood that the homeowner has been visiting Durham Avenue on a regular basis, no reports have been completed. It is essential that reference be made to Regulation 26 The Care Homes Regulations 2001 to ensure compliance. There are internal and external quality monitoring systems in place. Durham Avenue Care Home has achieved the externally assessed ‘Investors in People’ Award. This is only awarded when a certain quality standard has been achieved. Internal quality monitoring systems includes seeking the views of residents. This is achieved by way of sitting with each individual resident and discussing if they feel their needs, wants and wishes are being met. Resident’s meeting take place on a monthly basis that also provides opportunity for residents to have their say. In the past questionnaires for residents were provided but these proved unsuccessful with residents preferring a verbal approach. Anonymous questionnaires are made available for relatives and other interested people however again relatives prefer to discuss issues informally rather than through a more formal questionnaire. It was clearly evident that there is a good rapport between residents and staff that prompts a good exchange of verbal information sharing and residents were comfortable living at the home. A written statement of the policy, organisation and arrangements for maintaining safe working practices is available. Fire risk assessments are in place and environmental risk assessments are also undertaken when a risk has been identified in order to minimise that particular risk. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 28 Equipment is regularly serviced and a number of up to date certificates were evidenced that includes fire safety equipment, electrical installation certificate, gas certificate and employees liability certificate. Since the last inspection, all electrical appliances in the home have been tested with the test certificate valid until October 2007 when a re-test will be due. Staff training is in place regarding all key elements of health and safety. Fire safety is provided at induction and regular fire training and fire drills are conducted on a regular basis in respect of all staff and residents. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 29 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 3 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 3 X 2 X 3 X X 3 X 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 YA37 Regulation 8 Requirement Timescale for action 31/12/07 2. YA37 26 An application must be submitted in respect of a registered manager if the registered homeowner is not in full time day to day management of the home. When the registered 31/10/07 homeowner is not in day-to-day management control, the registered homeowner must visit the home on at least a monthly basis and produce a written report as to the conduct of the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA9 YA19 Good Practice Recommendations Risk assessments should clearly indicate when a form of restraint might be appropriate and the exact method the restraint should take. Suitable, safe heating equipment should be in place in all DS0000010073.V346511.R01.S.doc Version 5.2 Page 31 13 Durham Avenue 3 YA36 bedroom accommodation used by residents. Risk assessments should be in place as required with regard to any free standing heating equipment provided. At least 50 of the support worker team should achieve at minimum an NVQ Level 2 in care. 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 13 Durham Avenue DS0000010073.V346511.R01.S.doc Version 5.2 Page 33 - 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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