Inspection on 17/01/06 for First Choice Care Ltd 18 St Andrews Ave

This inspection was carried out on 17th January 2006.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

First Choice Care Ltd 18 St... 09/08/06

First Choice Care Ltd 18 St... 09/09/05

First Choice Care Ltd 18 St... 09/03/05

First Choice Care Ltd 18 St... 01/09/04

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

CARE HOME ADULTS 18-65 First Choice Care Ltd 18 St Andrews Ave 18 St Andrews Avenue Sudbury Middlesex HA0 2QD Lead Inspector Richard Adkin Unannounced Inspection 17th January 2006 2:00 First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 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 First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 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. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service First Choice Care Ltd 18 St Andrews Ave Address 18 St Andrews Avenue Sudbury Middlesex HA0 2QD 020 8904 5250 020 8904 5250 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 Divya Gandhi Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th September 2005 Brief Description of the Service: Mosaic House is run by a private company called First Choice Care Limited. The home is a semi-detached house, which has been extended on the side and back. It is situated in a residential area of Sudbury and is easily accessible by public transport. There is a garden to the back of the house, which is accessible to service users from the lounge and the kitchen. Mosaic House is registered for five adults with mental health needs. The statement of purpose states that it caters for Asian, African and Caribbean service users. All service users have single bedrooms. The accommodation is on two floors with two bedrooms, lounge/dining area, an office, a toilet/shower and kitchen on the ground floor. There are three bedrooms, one bathroom with bath and toilet; and the sleep in room on the first floor. Service users normally have been inpatients or users of other services before being admitted to the home. The aim of the home is to provide rehabilitation and support to service users and to develop their independent living skills with regard to being discharged back to live independently in the community. Some service users in the past have benefited from this approach and have achieved the goal of going back into the community. However, this may be difficult for other service users who may have to stay in the home for a longer period of time, during which time they receive on-going support. At the time of the inspection there were five service users in the home. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a midweek afternoon in January 2006. The focus of the inspection was to follow up the requirements and recommendations that arose at the previous unannounced inspection on 9th September 2005 and the remaining core standards. The Inspector met initially with Ms Priya Halai, the member of staff who was on duty at the time of the unannounced inspection and they were joined by the Manager, Mr Vinod Kabriya. What the service does well: What has improved since the last inspection? What they could do better: Individual written contracts and a statement of terms and conditions should be available for every resident. The smoky atmosphere in the living/dining area needs to be addressed for the health of residents and staff and an alternative smoking area established. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 6 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. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 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 First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 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): 5 Each resident needs an individual written contract with terms and conditions in order that there is clarity for residents. EVIDENCE: Residents have a copy of their own contract, but there was no copy on file and according to the Manager, these are not individualised. This needs to be rectified and cover the core areas of standard 5, such as terms and conditions of occupancy, personal support, fees charges, rights and responsibilities and so on. Residents should be supported in the drawing up of the contract with the Manager of the home. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 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 The individual plans of residents comprehensively reflect their assessed and changing needs and personal goals. EVIDENCE: A requirement that arose at the last inspection was that the registered person must ensure that all care plans are reviewed at least six monthly with the involvement of the resident as required. Evidence was seen in three files looked at by the Inspector, of service user plans. These are very detailed, relevant and comprehensive, but should be signed by residents who have participated in this process. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 10 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): 17 Food is stored appropriately and safely and a healthy diet is envisaged by residents. EVIDENCE: At the last inspection it was noted that items of food had been opened and stored in the fridge without having an opening date on them. It was also required that fridge and freezer temperatures were monitored on a daily basis. Records are now systematically kept in a folder, of the daily temperatures of the freezers and the fridge. There is also a section on the monthly cleaning and oil change of the fryer. One resident said there was often Indian food on offer and that he liked it when a cook comes and makes West Indian food. Residents were positive about the food available. Food looked at in the fridge was clearly labelled and dated. Food provided for the evening meal was freshly prepared and nutritious. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 11 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): 20, 21 The ageing, illness and wishes around death for residents are handled sensitively and respectfully. Residents are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The medication policy has been updated since the inspection by the CSCI Pharmacist in October 2005. There is now guidance from the GP about allergic reactions to medication for each resident. The local Pharmacist has provided training to the staff group recently, on aspects of medication. A requirement that has arisen on several previous inspections was the need to ensure that care plans addressed the future, along with the aspirations of residents. These care plans needed to address ongoing illness and death. Guidance needed to be provided to staff about dealing with these issues. The home has developed a format attached to each service user plan that looks at residents wishes in respect of ageing, death or terminal illness; this has been done sensitively. Residents have participated in completing this information and should be signing these. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 12 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 The home offers the opportunity for residents to express their view and act upon them. EVIDENCE: The Complaints Procedure was updated in July 2005 to include details of the Commission for Social Care Inspection. There was no evidence of any complaints in the last year. Residents spoken to felt able to express concerns to the Acting Manager. A recent meeting with residents was held where various concerns were raised and addressed with action being taken by staff members. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 13 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, 26, 28 The issues of ventilation where residents are smoking must be addressed to protect the health of residents and staff. EVIDENCE: A previous requirement was that areas in the home should be redecorated that were becoming jaded, such as the corridors, staircases and some resident’s bedrooms. The staircase and corridor have been repainted and double glazing installed. It was recommended that the home provide disposable hand towels for residents and staff in the communal toilets instead of cloth towels, which can be a source of cross-contamination. It was also recommended that the home develop a plan with regard to the redecoration of the home and with replacing fixtures and fittings in the home. These two recommendations remain to be fully addressed. One resident kindly showed the Inspector his bedroom and some of his possessions of which he was very proud. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 14 At the time of the inspection the living room was smoky and the lighting poor – a previous recommendation was that the registered person should consider making the living/dining areas brighter and more airy. This is now a requirement, as better ventilation and lighting is needed and consideration must be given to having a separate smoking area, separate from the living and dining area. The Acting Manager is looking at these areas with the registered provider. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 15 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): 34 The home’s recruitment policy and practices protect the residents from abuse. EVIDENCE: A significant requirement that arose at the last inspection and previously, was that the registered person must ensure that all new employees have an enhanced CRB check before starting work in the care home. In circumstances where the home is short of staffed, the registered person must ensure that the result of a POVA first check has been received and that once this has been judged to be satisfactory, the person can work in the home if supervised when in contact with residents. Three staff member’s files were looked at and the CRB enhanced disclosures were all in place. A system is in place to ensure that any new staff that come to the home will be working in direct supervision by a senior. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 16 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): 38, 39, 42 The health, safety and welfare of residents are promoted. EVIDENCE: The Acting Manager has just completed his RMA and is studying for NVQ Level 4 in Care. He has put his name forward for registration. The previous Manager left in August 2005. The registered person at the last inspection, needed to ensure that there was a fire risk assessment available for inspection; it was also recommended that designated staff for first aid have been sufficiently trained to undertake the task. Every member of staff has undertaken the first aid training and certificates were seen on files for September 2005. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 17 There is a Fire Safety risk assessment in place that will be fully reviewed by April 2006. This is a detailed assessment with over 50 areas examined; there were some gaps in action and timescales that should be completed. Residents’ meetings happen every two/three months. Quality surveys are in place for residents and yearly Service Plans are being developed. The Acting Manager informed the Inspector that the survey would be extended to carers and relatives. First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 18 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 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 1 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 3 X 3 3 X X 3 x First Choice Care Ltd 18 St Andrews Ave DS0000017493.V278201.R01.S.doc Version 5.1 Page 19 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 YA5 Regulation 4(2) Requirement Each resident must have an individual written contract and statement of terms and conditions with the home. A copy should also be available in the resident’s files. Better ventilation and lighting is required in the living room. Consideration must be given to having a smoking area separate to the living/dining area. Timescale for action 31/03/06 2. 3. YA28 YA28 13(c) 13(c) 31/03/06 31/07/06 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. 3. Refer to Standard YA6 YA24 YA26 Good Practice Recommendations Residents should be signing various plans where they have participated in discussion. It remains recommended that the home develops a plan with regard to the redecoration of the home and with replacing the fixtures and fittings in the home. It remains strongly recommended that the home provide disposable hand towels/or dryers for residents and staff in communal toilets instead of cloth towels, which can be a DS0000017493.V278201.R01.S.doc Version 5.1 Page 20 First Choice Care Ltd 18 St Andrews Ave 4. 5. YA38 YA42 source of cross-contamination. The process of registration should be completed for the Acting Manager. The fire safety risk assessment has some gaps in action and dates that should be completed. 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