Inspection on 23/10/08 for Elliot Avenue

This inspection was carried out on 23rd October 2008.

CSCI found this care home to be providing an Good service.

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.

Other inspections for this house

Elliot Avenue 23/08/07

Elliot Avenue 11/10/06

Elliot Avenue 31/01/06

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Elliot Avenue 1 Elliot Avenue Bretton Peterborough PE3 9TG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Elliot Avenue 1 Elliot Avenue Bretton Peterborough PE3 9TG 01733331731 01733331762 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Community Care Solutions Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: That the age range of service users will be 16 - 25 years only Date of last inspection Brief description of the care home Elliot Avenue was opened in May 2005 and is run by Community Care Solutions. The company operates residential homes specialising in the provision of care to adults with learning disabilities and associated challenging behaviours. The company has other homes in the Bedford, Peterborough, Rushden and Biggleswade areas. Elliot Avenue offers accommodation and support to 6 young people between the ages of 16 and 25 years. The basic fees for the home are agreed with social services and presented in individual contracts. A copy of the inspection report is kept in the office and is available to service users and their families. The home is situated in a quiet cul-de-sac in South Bretton and there is access to local shops and transport. 6 2 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The home was last inspected on 23/08/2007 and kept informing us, regulators, about significant changes or events. A survey was carried out from February 2008 and the home submitted their AQAA, Annual Quality Assurance Assessment to us in August 2008. We carried out an Annual Service Review in August 2008. This review indicated the need for an earlier inspection of the service, as the home had got a new manager, the number of incidents including restraints was relatively high and there were some indications of staff shortages on certain shifts. We visited the home on 23/10/2009 as an unannounced inspection visit. We met 5 young people who live there and spoke to two of them. We met with 5 staff and the manager of the home. We also spoke to the Service manager, the managers superior. We checked 3 young peoples files, staff files, medication process, process for dealing Care Homes for Adults (18-65 years) Page 5 of 28 with residents money, we toured the building and checked various documentation related to health and safety and the running of the home. After the site visit a relative raised an issue of planning and financing the residents holiday. The discussion about this issue was expanded to funding authority and we were informed of the content of these discussions. What the care home does well: What has improved since the last inspection? What they could do better: The home was aware of potential missing information when new residents are admitted, especially if the admission was on an emergency basis. However, they could improve records and, consequently, care and support if they ensure that all new information is properly recorded. An example showing this area for improvement was the failure to record in the care plan that a new resident was on medication, as discovered in the home after the initial information stated the opposite. Some care plans were not signed and it was suggested that relatives sign when the care plans are shared with them, thus confirming that users and relatives were informed about care plans. Although the money process was accurate and safe and protected residents, their Care Homes for Adults (18-65 years) Page 7 of 28 signatures on records would make it better and would promote safeguarding. The home would need to reconsider how the holidays for each individual were arranged, in relation to cost, and offer a holiday to each resident that they help choose and plan. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home had a good admission procedure, but the lack of information from referring agents on emergency admissions did not provide the opportunity for the home to assess and ensure that all needs would be met, if a person is admitted. Evidence: The latest admission showed that a relative, who insisted on a fast admission process for her son, was fully aware of the services and provisions in the home. The information both she and her son had was sufficient to make an informed decision. There were cases when the home did not get accurate and full information on admission. The home only discovered that a new resident was on medication upon admission. This was recorded in risk assessment, but not in the initial care plan. Despite the fact that the staff knew that he was taking medication, and that his review was planned for a months time, the lack of this information in his care plan could present a risk and must be recorded to ensure that potential new staff, or agency staff receive appropriate instruction about the care and support for each individual. The home assessed the risk for the restriction on admission for a resident to use Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: cleaning products, but through their own risk assessment decided to help him develop his independence further. This resulted in him being able to use cleaning products shortly after admission and to progress with developing his independence. The new admission case demonstrated how the home arranged to meet residents needs. A detailed care plan and appropriate risk assessment also contained goals for each individual. A new resident was provided with halal meals, according to his and his family preferences, due to religious beliefs. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed and well constructed care plans allowed staff to work with residents towards their set goals in a structured and agreed way. Evidence: Care plans presented in a new format for easier access to information were detailed and enabled staff to work accordingly. A review of two files showed regularity, every 6 months, but one plan belonging to a newer resident was not updated sooner, when the home identified that the resident was taking medication, while the care plan stated the opposite. However, the risk was reduced by addressing this important issue in a detailed risk assessment that instructed staff to administer medication as prescribed. Some family members were present at care plan review meetings for their relatives (the residents, although a signature to confirm their presence was missing in the care plans. Two young ladies (residents) confirmed that they knew about and take part in care plan reviews. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: One care plan clearly stated a limit for a resident to continuing with college attendance, but replaced it with improved leisure activities, where the risk for him was lower. A resident, coming from a Muslim family background was provided with Halal meals and this demonstrated how the home respected equality and diversity and promoted residents rights. A resident was observed initiating and holding a conversation with her key-worker. Trust and respect were present during this very positive contact. Only one resident did not attend college, due to high risk. One resident worked in the shop across the road. Observing a resident while she was making her breakfast also showed how residents made their choices. Communication abilities of all three case tracked residents were recorded. All residents contributed to the running of the home, taking part in cleaning, cooking and washing up in the home, according to the displayed rota. The home demonstrated how residents were encouraged to explore new fields in their life through an example of a resident who started using cleaning products for the first time in his life, since moving into the home. The manager also stated that new sofa covers and curtains were ordered after the residents indicated that they wanted a different style. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offered a choice to residents in constructing and leading the lives they wanted with all limits recorded in risk assessments. However, promoting the choice of holidays and providing these breaks for residents was determined by the financial and staffing resources provided by the organisation. Evidence: An example of a resident developing the skill to use the cleaning products showed that the home encouraged personal development. Five of six residents attended college, one was working in the local shop and all were taking part in leisure activities. The homes two vehicles provided greater flexibility for residents to attend activities outside the home. The issue of the vehicles breaking down often was to be addressed in the managers report to the organisation. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Some residents were using local facilities with staff support and only a high risk would prevent or limit the use of these facilities. This was recorded for a resident in one of the checked files. One resident was going to his parents on weekends. An issue was raised after the site visit of a residents plan for holiday. He was asked to contribute to the cost, due to his high needs. His relatives, the commissioning body, social services and the organisation were currently discussing the options. Two residents were observed chatting and helping each other, showing how good relationships within the home were promoted and encouraged. A structured daily programme for residents did not infringe on enjoyable leisure activities. Taking part in the house duties was shared and all residents were taking part in cooking and washing up, according to the agreed plan. Staff interactions with residents seen during the visit also showed that a friendly and supportive attitude was promoted and residents liked the closeness with staff. Three residents were observed choosing their breakfast and getting help and support from staff to get and prepare what they wanted. All comments received regarding food confirmed that a good choice and variety were offered. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good personal care ensured not only respect for residents, but also their general well being. Evidence: An example of good healthcare was seen during the site visit. A resident was assessed as needing dentist treatment. His care plan, daily notes and risk assessments all showed how this was managed and arranged a hospital dental appointment for him. Another example came from the observation of care in the home. A resident asked her carer to move from the lounge and discreetly asked her for help with a shower. The staff followed her into the shower room. The resident came out refreshed and happy with the support she received. A resident was in her dressing gown in the kitchen area, as she preferred to have her breakfast first and to dress afterwards. The home admitted difficulty in finding independent advocates for each individual, but the staff member spoken to confirmed that she would continue with her efforts to ensure that residents get an independent advocate. Good records from medical professionals involved in individual care were in care plans. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Also separate records of medical professional visits ensured that the staff monitored healthcare for each individual. Administering medication to a resident was observed and records for three residents also confirmed that the procedure ensured the safety of residents and accuracy of the relevant records. There were no residents taking prescribed controlled drugs. The storage for medication was appropriate. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were generally protected both with the policies and procedures and by staffs determination to ensure their safety and promote their rights. Evidence: The manager reported that there were no complaints, allegations or referrals to the POVA (Protection of Vulnerable Adults) register. All staff received up to date training on POVA and on Mental Capacity Act, thus improving protection of residents. All comments from residents confirmed that they knew how to complain and would be confident to do so if they wanted. The organisation and the home introduced robust procedures for the protection of residents. Staff spoken to were fully aware of the whistle blowing policy and procedure. The previous Annual Service Review reported: Four of the staff said they knew what to do if one of the young people living at the home or their relative was not happy with the service, and All three young people stated they knew who to speak to if they were not happy. However, the request of the organisation from a resident to contribute to his holiday financially, especially in relation to paying a portion of staff expenses, was still an unresolved issue among the relative of the resident, the commissioning body and the home. Care Homes for Adults (18-65 years) Page 18 of 28 Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoyed the homely feeling and were deciding on how to improve their home and make it even more homely. Evidence: The home was clean and bright on the day of the site visit. The bright colour of the sofa covers and non-matching colour of the curtains were addressed, on the residents initiative, with the manager who had already placed an order for replacement. A slightly torn carpet on the stairs, although it did not generally present a risk, or affect the general good look of the home, was something that the manager should address in the homes maintenance plan, as this comment came from residents who identified areas for improvement themselves. Situated next to the few shops and the library, the home provided easy access to local facilities. In addition, two vehicles and easy access to public transport also meant a wider choice for residents to take part in and use public facilities. The building retained the style of the nearby houses, thus creating a homely feeling. Internally the home was appropriate for the residents needs. The staff regularly recorded fridge and freezer temperatures, controlled water temperatures and managed to ensure safety and comfort for residents. The home had recently been inspected by the environmental health department and Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: the fire service and there were no issues resulting from these inspections. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefited from very committed, motivated and friendly staff team. Staff were appropriately checked and well trained to do their job. Evidence: On the arrival to the site visit it became clear that staff in the scheme were very good. Each staff observed knew what they were doing. Their relationship with residents was warm, supportive and respectful. The manager stated that the stable staff team should be brought to the full complement when two new workers receive their CRB (Criminal Record) checks and start working. The recruitment phases for them were completed and only this last part of the good checking process needed to be finalised. The manager explained that recruitment process was robust, with two full checks carried out on all new staff, at the HR (Human Resources) department at the organisational level and in the home, at the local level. The recent Annual Service Review reported: Staff have to complete a robust recruitment procedure before being appointed. Staffing levels are provided either on a one to one or two to one basis. New staff complete a comprehensive induction package. Training needs are identified by assessing the support needs of the young people living at Elliot Avenue and keeping these under review. A wide range of training Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: courses are offered to the staff team. The positive criticism received from staff resulted in additional different training on restraints, thus reducing the number of these incidents. Staff were very motivated to gain higher NVQ qualifications, mainly level 3, as many staff already held NVQ 2. Staff comments on training also confirmed that the training programme was wide ranging and included training on subjects directly influencing the standard of care for residents. Staff openly talked about their ambitions, motivation and potential areas for improvement. Some comments, already mentioned in the Annual Service Review included: The home makes sure the young people and staff come first no matter what the situation, the staff encourage the young people to be as independent as possible, they always have the choice of what to do during the day. The staff give the young people choice in all aspects their care. By appointing a full-time manager in this home, since May, the supervision programme had been improved, ensuring that staff were formally supervised 6 times a year, but also that they could consult the manager at any time. This, consequently, resulted in improved support for residents. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With the new manager in post, and with implementation of safe working practices the home regained stability in day to day operations, offering good care to the young people living there. Evidence: When the previous manager was promoted and progressed to a higher position, the new manager was appointed in May. He had the skills and experience necessary for the job. He continued to implement a similar ethos and working practices. Clear guidance and clarity of roles helped the home to stabilise the day to day work of the home. The organisation employed a quality manager and the quality assurance process was conducted at the organisational level. Questionnaires were used to collect information from people living and working in the home. The response to comments was evidenced by the order of new sofa covers and curtains, as residents wanted. The number of restraints used in the home was tackled by the introduction of different restraints training and by focusing on care for the resident who was subject to Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: restraints the most. The incident records were checked and a reduction of incidents was evident. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 All new referrals to the home should be fully assessed prior to admission, or within 48 hours following an emergency admission to the home, in addition to the assessment submitted by a referring agent. This would ensure that the home was clear about their abilities to meet all assessed needs of the user of the service. The care plans should be updated when the users needs change and as soon as the change has been identified should contain details of users medication and ensure consistency of care is offered and medication administration recorded accurately in all relevant records. The home should aim to offer a holiday to all of residents, which they help choose and plan, within the fees from the basic contracts. 2 6 3 14 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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