Inspection on 05/01/06 for Hulse Avenue

This inspection was carried out on 5th 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 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

Hulse Avenue 12/04/07

Hulse Avenue 05/07/05

Hulse Avenue 04/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hulse Avenue 1a Hulse Avenue Collier Row Romford Essex RM7 8NT Lead Inspector Mr Roger Farrell Unannounced Inspection 5th January 2006 1:45pm Hulse Avenue DS0000027856.V277127.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 Hulse Avenue DS0000027856.V277127.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. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hulse Avenue Address 1a Hulse Avenue Collier Row Romford Essex RM7 8NT 01708 735944 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) Outlook Care Susan Carillo Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: 1a Hulse Avenue provides accommodation and support for five people who have learning disabilities, some of whom also have a physical disability. Opened in 1992, it is run by Outlook Care Ltd, an organisation that specialise in providing housing and support services for vulnerable adults in North East London and Essex. It is a purpose built bungalow on a generous corner plot with a good-sized front parking forecourt. All residents have their own bedroom, some of which are equipped to help with physical disability. The layout of the home is helpful for residents that use wheelchairs - including wide corridors; special bath and shower facilities; and large communal rooms. The residents have their own vehicle, which has a tail-lift. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 1:45 and 4:45pm on Thursday 5 January 2006. The manager was available to deal with the inspector’s enquiries. She gave an overview of current support needs. Details of the occasional incidents of challenging behaviour were also discussed, and the plans to address the issues. The inspector gave the manager and deputy an update on changes due to be introduced in how services will be checked. Nearly all the core standards were checked at the last visit on 5 July 2005. A copy of that report is available at the home, or can be seen on the Commission’s website at www.csci.org.uk. Only one requirement was set – to improve the way staff keep day-to-day notes – and this has been done. At this recent visit the main areas looked at were staffing, management arrangements, and building safety checks. Four residents were at home, and three answered questions on the running of the home. In particular, the inspector welcomed the chance to meet with one resident along with a relative who visits regularly. What the service does well: What has improved since the last inspection? One service user is saying that he gets annoyed if there is noise in the house. From time to time this results in an incident. Although infrequent, the manager now feels this matter needs to be addressed as it can involve risk for others. She has consulted with a wide spectrum of people, and is pursuing plans that may result in this person having the chance to move to a flat. One recent letter from another resident’s family said – “We would like to say that in the year {our relative} has been residing at 1a Hulse Avenue, we have Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 6 never seen him so loved and happy. The care and attention that all of you give him exceeds our expectations, and feel he has at last found a ‘home from home.’ “ What they could do better: 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. Hulse Avenue DS0000027856.V277127.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 Hulse Avenue DS0000027856.V277127.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): 1, 2, 3, 4 and 5. The last report said arrangements covering the move-in of the two residents who joined this group last year were well planned and thorough. Good attention was paid to involving the residents, relatives and others familiar with the new people. One relative said - “There were no problems with the move in whatsoever. They do take account of what [my relative] and I say. Her bedroom was done according to her choice. She was shown cards and carpet samples….They do keep us informed about what is going on and what is planned.” At this recent visit that family member and the resident said they were still very happy. EVIDENCE: The manger had sent the inspector a copy of the updated ‘statement of purpose’ and the ‘service users’ guide’. These use lots of photos and pictures to help residents understand what the home offers, and include a pictorial ‘licencee agreement’. In July the inspector looked at the care files for the two most recent residents. These contained the required range of assessment paperwork in line with Outlook Care’s guidance. This included the detailed ‘referral form (registered care)’; good background information from social workers; and detailed notes covering the early stage of introduction and move in. Meetings had been held with the carers from the residents’ previous care home. The main ‘person centred planning (pcp)’ files had been set up at an early stage, with sections such as ‘likes and dislike‘ completed. One of the new residents told the Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 9 inspector how pleased she was, saying – “I like it here. I like the music…..[it has] nice big rooms. My bedroom is nice and tidy…..I like it best here.” The other recent resident’s family were also closely involved during his move, including attending the early reviews. This group of standards were all scored as satisfactory. At this visit the manager explained the steps being taken to consider the wishes of one resident who is saying he may like his own flat as he prefers quiet. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 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): 0 The last report described the care records as up-to-date, giving a good description of how support is agreed, provided and monitored. This involves positive steps to make sure residents’ individual choices are heard and acted upon. At this visit the manager described how day-to-day notes have been improved. EVIDENCE: This report carries forward the positive scores in all these areas. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 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): 11, 12, 13, 14, 15, 16 and 17. There is good evidence to show that residents are involved in varied and training, social and leisure activities, taking into account their preferences and abilities. EVIDENCE: Two residents told the inspector about how they spend their time. Both talked about their holiday to Lanzarote. One person said – “It was very good. The flight was lovely.” The ‘pcp’ files have sections on ‘Places I like to go’ and ’How I spend my week. This includes using the St Bernard’s Centre, Western Road Life Skills Centre, Yew Tree Lodge and Melville Court. Other regular activities include a drama club, music and movement sessions, the Spilsbury disco evenings, and a visiting massage service. One resident attends church regularly. Good use is made of the home’s vehicle, which is suitable for wheelchair users. This helps maintain a busy schedule of leisure activities, such as bowling, going to theatres and the cinema, trips to the coast, and meals out. The ‘pcp’ files have a section on family and social links. Again, all comments on meals were positive. The good scores for this section are carried forward in this report. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 12 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): 0 All these standards were reported as satisfactory in the last report. This included the care and medical monitoring for one person who passed away. The top ‘commendable’ score was given for the help provided to help one person achieve improved posture. EVIDENCE: Support files have medical tracking sheets; an annual health care forward planning grid; and suitable records and guidance on special needs. They show the involvement of physiotherapists, occupational therapists, and a speech and language therapist – and where appropriate a psychiatrist. Ahead of the last announced visit one health care worker wrote – “Staff are always friendly and knowledgeable about clients‘ needs. Clients appear cheerful and well cared for during my visits. Staff communicate well with myself and the psychiatrist regarding medication reviews and health needs.” Another health care professional said – “I have been involved with the staff at 1a Hulse Ave on a number of occasions through the treatment of patients and have been most impressed by their interest and enthusiasm involving the care of patients.” Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 13 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): 0 These two standards were rated as ‘met’ in the last report. There is suitable information and understanding about responding to complaints and other concerns. Last year the home experience of using the protection procedures, and this was done following the correct steps. EVIDENCE: The organisation’s complaints material is available at the home. This includes a named complaints coordinator, large print and pictorial guides, a complaints contact card, and a logging form. Details on how to make a complaint are on display in the office and on the residents’ notice board. The policies and guidance relevant to the protection standard are also available. This includes ‘Infringement of Service Users’ Rights Procedures’; ‘Whistle blowing’; ‘Abuse Management’; and versions of local guidance. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 14 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, 25, 26, 27, 28, 29 and 30. This is an excellently designed and maintained building that is well suited to the needs of residents, including those who use a wheelchair. EVIDENCE: The inspector again found the premises comfortable, bright, and clean. There are good design features that are helpful for people who use wheelchairs including level access to all parts of the bungalow, forecourt and garden; wide corridors and doorways; and communal rooms with sufficient travel and tuning dimensions. This well constructed premises is in keeping with the immediate neighbourhood. It is well placed for access to local services and shops, and the residents have their own minibus with a tail-lift. All fittings, furniture; and adaptations are of good quality, there being good attention to contemporary style home-making. The external re-decoration is in good order. The maintenance of the garden has improved now that outside gardening contracts are used. The organisation uses a fire safety consultant to carry out an annual risk assessment, and provide staff with refresher training. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 15 Three of the single bedrooms are a tiny fraction below 10sqm. The bedroom of the resident with the highest dependency needs who uses a special wheelchair measures 14.7sqm., with private access to the adjoining specialist bathroom. The other person who needs a wheelchair has a room that is just over 10sqm, however this is not problematic as she is able to self-transfer. The inspector looked at a sample of bedrooms. These are appropriately furnished, individually decorated, and each shows a high level of personalisation showing the resident’s individual tastes and interests. All have well positioned home entertainment equipment. Each bedroom has the required range of furniture and fittings, including vanity units. Bedrooms are fitted with smoke detectors, and all radiators have heat protective covers. The bedrooms of the two wheelchair users have electronic over-arm closers, and external doors. The bathrooms, shower-room and separate toilet facilities are suitable to the needs of residents. The large bathroom has ample space to allow assistance to the high dependency resident. This has been fitted with a different specialist bath with a riser action and is in a peninsular position. There is also a ceiling mounted tracking hoist in this bathroom, though a review by an occupational therapist confirmed that the mobile hoist is more suited to current transfer needs. The lounge is spacious, and has a conservatory extension. The kitchen and dining-room also have good space, there being lower work surfaces for those who use wheelchairs. The laundry has good working space, and was found to be clean and safely arranged. All stocks of bedding were fresh and in good condition, as was the case with residents’ clothing. The kitchen and laundry have suitable hand-washing facilities, and good stocks of protective gloves, aprons, and paper-towels were found. The home’s last independent infection control audit gave 100 for general household cleanliness, with an overall average score of 87 . Standard 30 is again rated at the ‘commendable’ level. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 16 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, 35 and 36. There is a well-established manager who leads a stable, suitably trained and qualified team. One resident said – “Sue {the manager} is lovely, and so are all the staff.” EVIDENCE: The team is made up of the manager; deputy; 7 full-time and 2 part-time support workers. Total care hours excluding the manager’s time equals 337. There is also money for a part-time cleaner post, but is used for periodic deepcleans by contractors. At this visit there was one support worker post vacant. Two staff are on long-term sick leave. Established staff do extra hours to cover gaps, along with a regular agency worker. The normal level of cover is two staff on both the early and late shifts (7am through to 9.30/10pm), with one person on waking duty at night – with shift overlaps for handovers. All staff take turns at doing the night shift. The level of qualification exceeds the expected level, with all staff having an NVQ at level 2 or above, except one person who is due to start on the scheme. The organisation has a good record on training and induction. Individual training profiles are maintained. All staff have completed, or are due to do the more detailed ‘safe handling of medication’ course. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 17 The inspector checked a sample range of staff files. This showed that the required checks are carried out, including - written references, CRB certificates, and documents that prove identity, as well as a recent photo. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 18 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, 40, 41, 42 and 43. Outlook Care are very good and running their services in an open and accountable way. There are a number of in-house and external service audit systems, good ways for residents to make their views known, and clear policies and procedures. This works well in providing monitoring and safeguards for those who use their services. EVIDENCE: A range of health and safety documents and certificates were checked. This included those covering fire safety and equipment maintenance; and electrical, gas and water certificates. These were satisfactory, though the fire system contractors need to confirm on their paperwork that they have checked the emergency lighting. There are a range of quality assurance systems. This includes regular ‘monthly visit reports’; specialist audits such as the medication arrangements; and external accreditation schemes. A new initiative had just been started to rewrite main policies and procedures in an ‘easy read’ format. There are also a number of ways service users can have a voice, including consultation forums, and involvement of advocacy services. Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 19 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 4 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X x 3 X 3 3 3 3 3 Hulse Avenue DS0000027856.V277127.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA42 Good Practice Recommendations Have available a document that shows that the emergency lighting has been checked by a competent person. 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