Inspection on 27/10/05 for Gainsborough Avenue, 1a

This inspection was carried out on 27th October 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gainsborough Avenue, 1a 29/08/06

Gainsborough Avenue, 1a 12/05/05

Gainsborough Avenue, 1a 23/09/04

Gainsborough Avenue, 1a 27/04/03

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

CARE HOME ADULTS 18-65 Gainsborough Avenue, 1a 1a Gainsborough Avenue Maghull Liverpool Merseyside L31 7AT Lead Inspector Mrs Janet Marshall Unannounced Inspection 27th October 2005 09:30 Gainsborough Avenue, 1a DS0000005244.V262361.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 Gainsborough Avenue, 1a DS0000005244.V262361.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. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Gainsborough Avenue, 1a Address 1a Gainsborough Avenue Maghull Liverpool Merseyside L31 7AT 0151 520 3176 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) Expect Limited Mr Carl Conlon Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 3 LD. Date of last inspection 12th May 2005 Brief Description of the Service: 1a Gainsborough Avenue is a small residential care home operated by Expect formerly Sefton Support Services. It is registered to accommodate three service users who have learning disabilities. Currently there are three women living at the home. The property is a detached dormer style bungalow situated in a popular residential area of Maghull. Its location is close to local amenities such as shops, public houses, and restaurants and is easily accessible to all forms of public transport. The home is well maintained both internally and externally and combines the requirements of a care facility with a comfortable domestic environment that gives no appearance of an institution. The philosophy of care continues to be focused on maximising independence for the service users and supporting them to achieve this. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspection visits are required at the home each year, this was the second. There has been no cause for any visits to the home since the last routine inspection in May 2005. This was an unannounced inspection that took place over 6 hours. Neither the residents nor staff knew that the inspector was coming. A partial tour of the home was conducted. The home was clean and tidy and is generally in good condition although there is some minor wear and tear evident. During the inspection residents were encouraged to carry on with their routines and take part in the activities they had pre-arranged for that day. At intervals throughout the inspection discussion with all three residents and a member of staff took place. Their comments and views about the home were obtained. A selection of care records and other required records were inspected. Records that were examined included residents care plans, daily diaries, medical notes, medication sheets, staff rotas and records of health and safety checks. The registration certificate, which is displayed in the hallway, shows details of the previous manager. A new one cannot be issued until the approval of a registered manager for the home. The new manager has completed an application for her approval, which is currently being processed. An up to date insurance certificate showing the appropriate cover was also displayed in the hallway. The requirements and recommendations from the last inspection were discussed and examined. What the service does well: Contracts are available for each resident, which show that they agree to the terms and conditions of the home. Information about residents is stored securely to ensure that their confidences are kept. Residents take part in a variety of activities both at home and in the local community, which are appropriate to their needs and wishes. Relationships are encouraged so that residents maintain contact with family and friends and have meaningful relationships. Residents are protected from abuse by the home’s policies and procedures. Staff are knowledgeable about residents and have a good understanding of their needs. Staff are qualified in or are undertaking vocational training. The manager provides staff with a good level of support and supervision, which ensures that they are aware of their roles and responsibilities. The homes recruitment process is robust ensuring the protection of residents. Health and safety procedures ensure the safety of staff and residents There is a relaxed and friendly atmosphere in the home. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: The homes Statement of Purpose and Service User Guide needs to be provided in a format that is more accessible to residents so that they have the information that they need about the home. The complaints procedure needs to be provided in a format that is more accessible to residents so that they can use it if they need to. The rotting woodwork on the conservatory needs repairing. The kitchen units and work surfaces, which are now looking worn in appearance, should be replaced. The bathroom furniture and décor in the first floor bathroom, which is old, worn and fading in parts should be replaced to ensure the dignity and comfort of residents. A seat must be fitted to the upstairs toilet ensuring the comfort and dignity of residents. The floor in the shower room, which is uneven, needs to be repaired to eliminate the hazard to residents. The locks on both bathroom doors, which are broken, need to be repaired or replaced to ensure the privacy of the residents. The downstairs bathroom needs extra handrails so that one resident can get about more easily. The broken handles on one residents bedroom furniture need replacing so that she can use them without difficulty. A written refurbishment plan should be produced outlining planned action for the next twelve months. Please contact the provider for advice of actions taken in response to this Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 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 Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Information about the home is not available in a format that can be easily accessed and understood by residents. Assessment information for all residents was available so that care needs will be met. Contracts were available for each resident to show that they agree to the terms and conditions of the home. EVIDENCE: The homes Statement of Purpose and resident Guide that was viewed at the last inspection was only available in small type, which one resident found difficult to read. The resident said that the print is too small. A requirement was given for the home to provide the information in format, which could be easily accessed by residents. This has not yet been done. The manager said that the company are in the process of reviewing and improving the accessibility of all documents including information about the home and it will soon be available. At the last inspection the manager was unable to find assessment information completed by the home for a newly admitted resident. The information was seen at this inspection. It showed that the manager of the home carried out a full and proper assessment prior to admitting the resident. A contract was available in each of the residents care files, they have been signed by the resident and/ or their representative to show they agree with the terms and conditions of the home. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 10 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, 7, 8, 9 & 10 Care plans for all residents have been reviewed and updated with the involvement of residents to ensure that changing needs are met. Independence is better encouraged to allow residents to develop their daily living skills. Residents care plans reflect they are encouraged to make decisions and take responsible risks in their lives, which are safe and effective. Information about residents was stored securely to ensure that their confidences are kept. EVIDENCE: Care plans seen at the last inspection showed that they had not been reviewed for sometime therefore did not encourage residents independence, or were not a true reflection of changing needs. At this inspection care plans for all residents showed that they have since been reviewed and updated. Care plans are signed showing the involvement of residents and/or their representatives. Care plans have been presented into an individual format appropriate to the needs of residents. Each care plan highlights the needs that residents have and include reference to any risks present or issues with respect to behavioural needs. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 11 All care plans are accessible to the staff team and show that they are involved in the development of them. When not in use care plans are kept locked away with other information about residents. A resident said that she knows where her care plan is kept and that she can ask for it at any time. Care plans and daily records show that residents are encouraged to make decisions with the support that they need. One resident said that the staff involve her in aspects of the home. She gave the following examples: “I join in meetings with the staff and talk about what I would like to happen” “The staff are all very good, they never talk over me they include me in discussions” “The staff are always asking me if I am happy and if there is anything I would like different or would change”. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 12 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): 11, 12, 13, 14, 16 & 17 Residents are given opportunities for personal development, which encourages independence. Residents take part in a variety of activities both at home and in the local community, which are appropriate to their needs and wishes. Relationships are encouraged so that residents maintain contact with family and friends. Residents are encouraged to eat food that is healthy and enjoyable which ensures their health and wellbeing. EVIDENCE: Each resident has a personal development plan, which have been improved since the last inspection to show that they are given more opportunities to learn and develop life skills in the home. A member of staff was seen supporting a resident in the kitchen, which was consistent with her personal development plan. Discussion with residents and records showed that all residents continue to take part in a varied programme of activities at home and in the local community. Since the last inspection, one resident has made some changes to Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 13 her daytime activities. Another resident said “I go out a lot, I went on a trip to Blackpool last week with my mother and another resident, a member of staff is taking me to the hairdressers this afternoon”. One resident talked about her boyfriend who visits her regularly, she said that “he often stays for a meal and we spend time alone or in the company of other residents who he gets on well with”. One resident said, “I would like to do some work on a computer”. This was discussed with the manager who said that the home does not have access to a computer, but will help the resident find out how she can pursue her interest. One resident accesses the community on a daily basis and has one to one staff support. This is in line with her risk assessment and her needs. The resident also has regular contact with her father who takes her out each Sunday. There was plenty of fresh, tinned and frozen foods kept at the home. Staff spoken with said they involve residents in shopping for food and in planning menus. A resident confirmed this. Comments made by residents included:” I go shopping and choose the food I like”, I like the food, but sometimes I get too much, I don’t like big portions”. “I help to cook”, “We always have lots of fruit in the house”. A three-week menu showed that residents eat food that is healthy and well balanced. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 14 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): 19 & 20 Information about residents health care is better recorded ensuring that their health care needs are understood and met. Residents who are prescribed medication are protected by the home’s medication procedure. EVIDENCE: At the last inspection records showed that residents health and personal care had not been reviewed for sometime, potentially putting residents at risk of not having their needs understood and met. New information shows that care files have since been reviewed and updated. There is now good information, which show that residents health care is monitored and that they access the appropriate health care facilities at the required intervals. One resident said, “When I need to I make an appointment to go and see my doctor at the surgery which is near by”. She also said “ I have regular eye tests and I go to the dentist, the staff are very good, they remind me about appointments and help me with them when I ask”. Medication sheets seen were completed to a good standard. Medication was stored safely in the home. A record of all medication that goes in and out of the home is kept. Medication training has been provided to all staff that administers medication. Gainsborough Avenue, 1a DS0000005244.V262361.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): Residents are protected from abuse by the home’s policies and procedures. Residents cannot easily access the complaints procedure. EVIDENCE: Following the last inspection a requirement was given for the complaints procedure to be made more accessible to residents. This has not yet been done. The manager said that the company are in the process of making all policies and procedures more accessible to residents including the complaints procedure. The home has robust procedures for responding to suspicion or evidence of abuse or neglect. They include a Whistle Blowing procedure and the Local Authorities Protection of Vulnerable Adult procedure (POVA). The homes complaints procedure gives details of the Commission as a contact for residents, their families and staff if they wish to raise any concerns or for advice. No complaints or allegations of abuse have been made to the Commission. Physical and verbal aggression is understood and well documented. The necessary procedures are in place to ensure her safety and that of others around her. Records show that staff have undertaken training, which helps them protect residents from abuse or neglect. One member of staff confirmed her understanding of the home complaints and POVA procedures. One resident said “I am really happy here, if I wasn’t I would not be afraid to tell somebody”. Another resident said, “Yes I do know that if I am unhappy I can complain to somebody, I am very happy”. Gainsborough Avenue, 1a DS0000005244.V262361.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, 27 & 30 Residents do not live in a completely safe and comfortable environment. EVIDENCE: A tour of the premises was carried out. All parts of the home were clean and hygienic. The property shows no obvious signs of being a residential care home. It is attractive and well maintained like other houses in the area. Large potted plants and various other shrubs, which are well kept, are displayed around the front garden. One resident said, “I still love gardening, I get out there whenever I can”. The environment shows some signs of minor wear and tear. The small conservatory linked to the back of the house has some wood rot which needs repairing. The kitchen units and work surfaces are now looking worn in appearance, some units are broken. The manager said, “They have been repaired several times but keep breaking”. These should be replaced. The second lounge area has been stripped in preparation for re-decoration. The manager said that discussion has taken place with residents about colour schemes and furniture for the room. One resident said “it will provide a nice quiet area for me to sit with my friends when they visit”. There are two bathrooms, one on the first floor of the home and one on the ground floor. The bathroom furniture in the Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 17 first floor bathroom is old and fading in parts the toilet does not have a seat and the décor has become tatty. The light bulb is exposed because there is no lampshade and the radiator is rusting in parts. The floor in the shower room is uneven which causes the water to collect. This poses a hazard to residents. Improvements should be made to the bathrooms to ensure the dignity, comfort and safety of residents. The locks on both bathroom doors are broken they need to be repaired or replaced to ensure the privacy of the residents. The downstairs bathroom is fitted with handrails, however one resident said that she would like more near the shower and toilet so that she can get about more easily. This was discussed with the manager who said she would make a referral to the Occupational Therapist. One resident provided a tour of her bedroom. She said that she likes her room. The resident said that she enjoys spending time alone in her room listening to music and watching TV. Some handles on her wardrobe and chest of drawers are broken, they need replacing so that she can access them without difficulty. In general, the Manager does not have clear information about which parts of the home will receive refurbishment. A written refurbishment plan should be produced outlining planned action for the next twelve months. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 18 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): 36 & 34 Residents benefit from a staff team who are fully supervised and supported. The homes recruitment process is robust ensuring the protection of residents. EVIDENCE: The manager said that she is regularly supervising staff on a one to one basis. Records and discussion with a member of staff evidenced this. Supervision records are kept in a secure place and can only be accessed by the manager. The manager and a member of staff said that discussions between them also take place daily in addition to regular staff meeting. Supervision of staff ensures that they are appropriately supported and fully aware of their roles and responsibilities. Two staff files were examined. They showed evidence of Criminal Records checks, two references, medical declarations and information to confirm the member of staff’s identity. Staff files are locked away safely and can only be accessed by the manager, which ensures staff confidences, are kept. Gainsborough Avenue, 1a DS0000005244.V262361.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 & 42 The manager has forwarded onto the Commission for Social Care and Inspection an application for her approval as registered manager. Health and Safety checks ensure the protection of residents. EVIDENCE: The manager has forwarded onto CSCI an application for her approval as registered manager of the home, however it cannot be processed because a reference has not yet been received. The manager showed that she has applied for the reference and the shortfall is the failing of somebody else. Fire records showed that alarms are tested weekly and fire drills take place at the required intervals involving residents and staff. Accident records are well kept. Sinks are fitted with regulators but the temperatures are checked on a regular basis. Information is available for staff on cleaning products and substances that are potentially hazardous to health. Radiators are fitted with thermostats, which minimise scalding. Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 20 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 2 3 X X 3 Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 X 2 X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gainsborough Avenue, 1a Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X X X X 3 X DS0000005244.V262361.R01.S.doc Version 5.0 Page 21 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. 2. 3. 4. Standard YA1 YA22 YA24 YA26 Regulation 5(1) 22 23(2)(b) 23(2)(n) Requirement A service user guide must be produced in a format that is accessible to service users. A complaints procedure must be produced in a format accessible to service users. The floor in the shower room must be repaired. Extra handrails must be fitted to the shower room. Timescale for action 12/12/05 12/12/05 15/12/05 31/01/06 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. 4. 5 Refer to Standard YA24 YA24 YA24 YA24 YA24 Good Practice Recommendations The kitchen units and work surfaces should be replaced The bathroom suite on the first floor should be replaced A refurbishment plan relating to the home for intended work over the next twelve months should be produced A lampshade should be fitted to the upstairs bathroom The upstairs bathroom should be redecorated Gainsborough Avenue, 1a DS0000005244.V262361.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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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