Inspection on 07/11/05 for Edenvale

This inspection was carried out on 7th November 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 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

Edenvale 04/01/07

Edenvale 22/02/05

Edenvale 30/06/04

Edenvale 03/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Whitworth Lodge

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

CARE HOME ADULTS 18-65 Edenvale 22 River Avenue London N13 5RU Lead Inspector Brian Bowie Unannounced Inspection 7th November 2005 08:00 Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 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 Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 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. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Edenvale Address 22 River Avenue London N13 5RU 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) 020 8882 3261 020 8866 7968 Mrs Bee Looi Bennett Mrs K Justin Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two specified service users who are over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as either of the specified service users vacates the home. Date of last inspection 16th May 2005 Brief Description of the Service: Edenvale is a small care home which provides accommodation and care for seven adults who have a learning disability. The majority of theresidents have lived together at the home for a number of years. The home is a large house with three floors. The top floor is for staff accommodation. There are three single rooms and two shared bedrooms for residents. There is a lounge, dining room and a small quiet room downstairs with a small garden at the rear. The home employs some Chinese-speaking staff to meet the cultural and linguistic needs of the two Chinese residents. The home is close to local shops and facilities and public transport. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted 6 hours. The owner and manager were both interviewed and helped with the inspection. The home was looked round and all 7 residents were seen, with 2 of them interviewed. Members of care staff were also spoken to. A variety of records, including careplans and health & safety documents, were looked at. The overall impression from the inspection was of a home that is providing an excellent standard of care within a very friendly, homely and supportive environment. What the service does well: What has improved since the last inspection? The management team at the home have continued to help staff to think more about how best they can support the residents and to find new ways to Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 6 encourage people at the home to be able to do as much as they can for themselves. Staff and managers at the home are being trained in personcentred planning so that Edenvale becomes even more focussed on providing a service which is built around the needs and wishes of the individual residents and which gives them a greater say in how the home is run. This is now beginning to be reflected in the individual plans of care for each resident. The staff team has been strengthened with the addition of new staff experienced in the learning disability area who are having further training in how best to support people with learning disabilities. At the previous inspection there had been 1 area for the home to improve and this had been dealt with. 2 recommendations to improve care practice had also been made and these had both been followed up. What they could do better: 2 new areas for improvement were identified at this inspection. • • Recruitment procedures for new staff Fire safety risk assessment of the premises 4 recommendations are made about how to improve further care practice in the home. • • • • Adding an outcome column to the complaints form Making more use of the home’s suggestions form to record how residents’ ideas have contributed to the running of the home Making more use of advocates and other independent parties to help residents fill in their feedback questionnaires about the service they receive at Edenvale Ensuring residents’ meetings are held very regularly so that as a group residents can even more say in how the home is run. The owner and manager at the home emphasised that they are keen to work closely with CSCI to raise standards even further at the home in order to continue to provide the best possible quality of life for residents. 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. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 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 Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People moving into the home have their needs and wishes assessed so that the home can be sure that it can meet these needs and wishes. EVIDENCE: All seven of the residents were seen with 2 spoken to at length. They said that they enjoyed living at the home and thought that their needs were being met. One resident said: ‘I like it here. I get help when I need it.’ The high satisfaction level of residents with the home indicated that the home is good at selecting residents who will benefit from what the home offers and that residents’ needs and wishes are being responded to. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,8, Residents benefit by having careplans which set out clearly and in detail how their needs and wishes will be met by the home. The home is good at helping residents to contribute their views and ideas on how the home is run. EVIDENCE: One care plan was looked at in depth. The records on this individual were comprehensive, detailed and up-to-date. This individual had had some significant additional health needs recently which the home had responded to very well so that the person had been able to return to the home from hospital earlier than planned. This resident has complex needs which the staff are working hard and effectively at meeting. At their annual review the psychiatrist had written: ‘This person is progressing very well at Edenvale.’ Care staff interviewed were aware of the need to provide guidance and support to residents where necessary, whilst letting them decide for themselves as much as possible how they led their life. Residents said they had meetings where they discussed the running of the home and made suggestions about what they wanted to do, such as where to go on holiday. Notes of these meeting showed that residents’ ideas and suggestions were being followed up Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 10 and where possible implemented. However there had not been a recent residents’ meeting. It is recommended that these meetings are held very regularly since they are a key part of the residents, as a group, being able to contribute their suggestions and views on how the home is run. It is also recommended that the home’s suggestions form is used to record examples of how residents’ comments and ideas have been taken up as a way of showing clearly that residents are having an increasing say in how the home is run. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15,16 Residents are getting a better quality of life because they take part in a range of stimulating activities, the attention paid by the home to meeting cultural needs and the close contact residents have with friends and family. Residents benefit by having staff who allow them to make choices for themselves and to have as much control over their life as possible. EVIDENCE: Residents take part in a variety of daytime activities, including day centres, work projects and college classes. Feedback from residents and staff showed that residents get out and about in their local community, including going shopping, to the cinema and on outings, as well as going on holiday with the home. The home is good at meeting the cultural needs of the two Chinese residents who both go to a Chinese community centre and when they wish to an appropriate place of worship in Soho, and benefit by having Chinese-speaking staff working at the home. Another resident goes to 2 of the local churches and considered that: ‘I worship where I want, when I want.’ Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 12 In some cases residents were having regular visits by family members to the home which they clearly valued. Residents said that their friends and relatives were welcomed when they visited them at Edenvale. A professional involved in the home had written on their feedback questionnaire: ‘ Staff and clients are very welcoming.’ ‘I go to bed when I want’ was the comment of one resident. On the day of inspection this individual had chosen to have a lie in and got up later. Staff interviews and the care plans indicated that Edenvale is giving careful thought about how they can empower the residents and increase the choices they can make over how they live their lives. Staff and managers are both attending person-centred training in order to promote this area further within the home. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,20 Staff are good at supporting residents in a way which the residents are happy with and which makes sure their physical and emotional health needs are met. Residents benefit from there being effective arrangements regarding medication in the home. EVIDENCE: ‘My keyworker helps me a lot- she talks to me, helps me sort out personal problems. If I need clothes she takes me to the shops.’ This was the view of one resident. Other residents also indicated by their manner and behaviour that they felt relaxed and supported and cared for when staff were around. The close family-like atmosphere in the home helps individuals with challenging behaviours and high anxiety levels to feel more relaxed which in turn enables them to have improved relationships both with other residents and with staff. A professional involved in the home had written on their feedback questionnaire: ‘Staff seem to relate empathetically and appropriately with residents.’ The home is encouraging and enabling residents wherever possible to take as much responsibility as they can safely manage in relation to taking their medication. The records relating to the administration of medication to Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 14 residents were seen and indicated that a detailed and accurate record is being kept. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home deals well with complaints so that residents and relatives feel confident their complaints and concerns will be listened to and acted on. The residents benefit from adult protection procedures which make sure that residents are safe and secure whilst at Edenvale. EVIDENCE: Staff have attended training courses on how to protect vulnerable adults from abuse and know what to do if they think a resident has been the victim of any form of abuse. The home had copies of the special ‘alerting’ forms used when any incident of abuse is suspected so that Social Services are informed and the proper follow up action taken. The manager was advised to get the latest edition of the local authority’s adult protection procedures. The home has policies and procedures in place in relation to reporting and investigating complaints. The complaint record showed that no complaint had been made since the previous inspection. Residents said they felt able to make complaints and raise issues if they needed to. Staff actively encourage residents to voice their concerns and complaints, which they do, so that these can be responded to quickly. It is recommended that an extra column is added to the complaints form so that the outcome of complaints is clearly recorded. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Residents at Edenvale enjoy an attractive, comfortable and clean living environment which adds considerably to their quality of life. EVIDENCE: Edenvale provides a very homely, comfortable and clean environment for residents, with improvements made since the last inspection in terms of the decoration and furnishings. Residents commented that it was a nice environment to live in. One of the residents said: ‘It’s better now it’s decorated, and it’s always kept clean.’ On arrival at the home a member of care staff was seen cleaning and hoovering. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 Residents benefit from a committed and experienced team of staff who have the skills and training to meet their needs. Residents are not fully protected by the home having sufficiently rigorous recruitment procedures for new staff. EVIDENCE: Care staff were interviewed and said they worked closely with each other in order to meet the needs of residents. Written and verbal feedback from both residents and relatives was positive about staff. One new member of staff said: ‘I really enjoy it here. The client comes first.’ Edenvale has six full time staff plus part-time or bank staff. Several members of staff are qualified to NVQ level 3 in care and the registered manager has completed her NVQ level 4 training. New staff have a well planned and thorough induction into the roles and responsibilities of being a care worker. The staff team has attended a range of relevant courses, including adult protection, care planning, administration of medication, challenging behaviour, and more recently person-centred planning. This has helped staff to gain the knowledge and develop the skills to provide a high standard of care and support to the residents. As a result the home is succeeding in meeting the diverse needs of the current group of residents. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 18 Some staff files were looked at and contained most of the information needed to make sure that all new staff in the home have had the appropriate checks made. However two new members of staff had started working at the home without a new CRB disclosure having been received or a POVA (Protection of Vulnerable Adults) First check carried out, on the basis that these staff had recent satisfactory disclosures. Current policies make clear that when care homes appoint new members of care staff a fresh CRB disclosure must be obtained, before they start work, or in special circumstances a POVA First check undertaken. These procedures help to ensure that residents are protected from unsuitable staff. Edenvale must make sure that before any new member of staff starts working at the home either a satisfactory CRB disclosure or POVA First check has been received. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Residents really benefit from living at Edenvale because the home is run in the best interests of the residents with their views and wishes shaping how the home is run. The home is good at making sure the residents are kept safe and secure whilst living at Edenvale, but need to improve further fire safety measures to ensure the home is as safe as possible. EVIDENCE: The manager and owner work closely together to achieve high standards for the home. Feedback from both residents and staff was positive about the way in which the home is run. A relative had written on their feedback questionnaire: ‘Edenvale is doing an excellent job, and should be left alone to get on with it.’ As a result what the residents get out of the home is a very caring and supportive place to live where they are being helped to get as much as possible out of life. An annual survey is carried out to get feedback from residents, relatives and professionals on how they think the home is doing. In addition there are Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 20 regular monthly checks on the standard of service offered by an independent auditor. Both managers and staff gave the message: ‘We’re trying to improve all the time.’ Staff help residents to complete questionnaires so that they can give their views about the home. It is recommended that where appropriate independent parties, such as advocates, are used to enable residents in a variety of ways to express their comments and suggestions about the home. A range of records was looked at, including health and safety and fire safety. In general these records were detailed, up-to-date and accurate and confirmed that the home is being run responsibly with essential checks being made and acted on. Fire drills are held regularly so that residents now know what to do if the alarm rings and react appropriately and quickly. In line with guidance from the LFEPA the home must have an up to date fire safety risk assessment of the premises. Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 21 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 3 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x 3 x x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 4 2 x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Edenvale Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 4 x 3 x x 2 x DS0000010584.V257940.R01.S.doc Version 5.0 Page 22 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 YA34 Regulation 19 Timescale for action The registered persons must 21/11/05 ensure that before any new member of staff starts working either a satisfactory CRB disclosure or POVA First check is received. The registered persons must ensure that an up to date fire safety risk assessment of the premises is made. 21/11/05 Requirement 2 YA42 23 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 YA8 YA8 Good Practice Recommendations The registered persons should ensure that residents’ meetings are held very regularly. The registered persons should ensure that the home’s suggestions form is used to record examples of how residents’ comments and ideas have been taken up. DS0000010584.V257940.R01.S.doc Version 5.0 Page 23 Edenvale 3 YA22 The registered persons should ensure that an extra column is added to the complaints form so that the outcome of complaints is clearly recorded. The registered persons should ensure that where appropriate independent parties, such as advocates, are used to enable residents in a variety of ways to express their comments and suggestions about the home. 4 YA39 Edenvale DS0000010584.V257940.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. 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