Inspection on 05/07/05 for Hulse Avenue

This inspection was carried out on 5th July 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hulse Avenue 12/04/07

Hulse Avenue 05/01/06

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 Roger Farrell Unannounced Inspection 05 July 2005 10:30 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 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 Stationary 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 G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hulse Avenue Address 1a Hulse Avenue, Collier Row, Romford, Essex RM7 8NT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01708 735944 Outlook Care Susan Carillo CRH Care Home 5 Category(ies) of LD Learning Disability (5) registration, with number of places Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27 January 2005 Brief Description of the Service: 1a Hulse Avenue provides accommodation and support for five people who have a learning disability, some of whom also have a physical disability. Opened in 1992, 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 G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Tuesday 5 July 2005, between 10.40 am and 1.20pm. The manager was on duty and was helpful in responding to the inspector’s questions, and showing him the records he asked to see. The inspector asked for copies of some records and these were sent on to him a couple of weeks later. The inspector appreciates the efficient way the manager deals with inspections. One resident who was at home showed the inspector around the building. A member of her family visited, and the inspector appreciates the time he and this resident took to meet with him separately. One other resident returned later and also made comments. At the last announced inspection there was one vacancy as one person had moved on to more independent accommodation. Sadly, one resident whose health was deteriorating passed away last year. Two new residents have joined this household group – one moving in last August, and another in November. The areas checked at this visit included the action taken on the six requirements made in the last announced inspection report; how the new residents were assessed; seeing if care plan files are being kept up to date; how residents are helped to be involved in training, social and leisure activities - and maintain links with family and friends; and the arrangements to deal with complaints and other concerns. What the service does well: This home continues to be able to show that it is running well. Sue Carillo is now well established as the manager. An experienced support worker has been helping as the acting deputy, and a new deputy was due to start a week after this visit. There is a stable team of support workers who have a good understanding of residents’ support needs, ways of communicating, and how they like to spend their time. They have coped well with the changes that have occurred over the past year, including helping two new residents move in. The building is very good, and is kept in excellent condition. One of the residents who moved in last year said – “This is the best home I have been in. It is a really nice home.” Her brother added – “I don’t think it could be made better. There is always enough staff. I get invited to all meetings, including the house meetings every three months…You are always made to feel welcome.” The manager described the support that is provided to the other relatively new resident, saying – “We need to be alert as his mobility is deteriorating…but it is great as staff at his day centre say he is communicating and interacting much better than was the case before.” Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4 and 5. The arrangements covering the move-in of the two residents who joined this group in the last year were well planned and thorough. Good attention was paid to involving the residents, relatives and others familiar with the new people. EVIDENCE: The manger 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’. 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 dislikes ‘ completed. One of the new residents and a family member told the inspector how pleased they were with the move-in arrangements. One comment was – “There were no problems with the move in whatsoever. They do take account of what [my relative] and I say. Her bedroom was done Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 9 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.” The resident added – “I like it here. I like the music…..[it has] nice big rooms. My bedroom is nice and tidy…..I like it best here.” This group of standards are scored as ‘met’. The other recent resident’s family were also closely involved during his move, including attending the early reviews. Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8, 9 and 10. The care records are now more 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. EVIDENCE: The inspector looked at a range of ‘person centred planning’ (pcp’) files; the ‘mirror files; the ’health mirror files’ and the individual daily diaries. The files are well arranged in line with the ‘person centred planning’ framework used by the organisation. These include a comprehensive series of needs assessments under appropriate user-friendly headings, which lead on to the action plans and risk assessments. The main sections of the files are designed to fully involve the resident in the support processes, and understanding is helped by the use of pictures and photos. There are monthly review sheets, including details of activities that took place that month. All residents had a ‘pcp review’ last October. An advocate attended these, except in one instance where a relative was present. Although there were some gaps one ‘pcp’ files where the resident is a bit resistant to participate, the requirements set in the last report have been achieved. This includes updating the helpful ‘need to know’ file. The inspector did say that the manager still needs to encourage staff to say what Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 11 assistance they have provided when using the day-to-day diaries, therefore this requirement has been carried forward. Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15, and 16. There is good evidence to show that residents are supported to be involved in a varied and stimulating training, social and leisure activities, taking into account their preferences and abilities. EVIDENCE: The manager provided the inspector with details of each resident’s regular weekday involvement in training and activities centres. 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. Individual files have a monthly report on social and leisure activities. One resident can be resistant to attending some of his planned sessions, but this was being monitored to see how this might be linked to his seizure pattern. Both residents seen at this visit talked positively Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 13 about trips and holidays. One resident commenting – “I do get out a lot….I do drama on Tuesdays…and go to [Melville Court] on Wednesday and Thursdays. On Mondays I go shopping with my brother.” This relative praised the support for going, adding – “In other homes we had to pay for extras such as holidays, including staff costs. Here it is all paid for.” The manager expressed her appreciation of this relative’s support, such as covering the cost of extra satellite channels being installed at the time of this visit. Another resident described how he was looking forward to the next holiday, with four residents and three staff going to Lanzarote. The fifth resident was planning a break at a holiday camp. The ‘pcp’ files have a section on family and social links. One resident stays with her family most weekends. These standards are met. Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 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 standard(s) 18, 19, 20 and 21. The inspector is satisfied that proper attention is paid to assisting residents with their medical and physical needs, including help with personal care. This is an enabling regime for all residents, including those with physical disabilities. There is good documented evidence on health care monitoring - including keeping aids and adaptations under review, such as liaison with a physiotherapist. This has resulted in one resident recently gaining improved movement. This example means that the home retains the top ‘commendable’ rating for Standard 19. EVIDENCE: The descriptions of the support residents receive from all health care professionals are positive. This included the GP practice across the road where all residents are registered, the doctors who do home visits where this is more suitable to the needs of a resident. 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. Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 15 One resident has severely limited mobility, and the manager described the significant improvements she has achieved since recently getting a new more upright matrix chair, saying – “The change is amazing. She can now stand and get into bed….this is a great improvement, and is opening up all sorts of opportunities.” This residents susceptibility to pressure sores is monitored. 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.” The file of the resident whose health deteriorated last year, and who sadly died, showed that there had been regular reassessments by a broad range of health professionals, including physiotherapist; dietician; and speech therapist – there being up-to-date advice on such matters as exercises, swallowing and weight monitoring. The last inspection was carried out by the Commission’s pharmacy inspector. The manager presented the ‘action plan’ she had prepared in response to the improvements suggested, showing that all areas had been addressed. Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 16 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 standard(s) 22 and 23. There is suitable information and understanding about responding to complaints and other concerns. The home had recent experience of using the protection procedures, and this was carried out 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. There have been no complaints logged since the last announced inspection. The policies and guidance relevant to the protection standard are also available. This included ‘Infringement of Service Users’ Rights Procedures’; ‘Whistle blowing’; ‘Abuse Management’; and versions of local guidance. The manager talked through the outcome, processes and effects of a recent incident involving restraint, which had included following the adult protection procedures. She said – “All staff have done the two-day ‘positive response’ training. It was excellent…Overall I think the matter was handled well. [The social worker] was really helpful. I think positive lessons have been learnt, especially on how to monitor and diffuse difficult events.” Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 17 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 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 with a physical disability. EVIDENCE: The inspector again found the premises comfortable, bright, clean and free from offensive odours. 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 redecoration is in good order, with freshly planted hanging pots. 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 G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 18 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 reflecting the resident’s individual tastes and interests. All had 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 combined 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 fitments, and good stocks of protective gloves, aprons, and paper-towels were found. The home had an independent infection control audit last achieving 100 for general household cleanliness, with an overall average score of 87 . Standard 30 is rated at the ‘commendable’ level. Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 These standards were not checked at this visit. How staff are vetted will be covered at the next visit. EVIDENCE: Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 These standards were not covered at this inspection. Outlook Care continue to send the Commission copies of their monthly reports. EVIDENCE: Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 4 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hulse Avenue Score 3 4 3 3 Standard No 37 38 39 40 41 42 43 Score x x x x x x x G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 22 Yes 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 YA6 Regulation 15(1) Requirement Provide staff with guidance on recording in day-to-day monitoring records the support that has been provided, and any significant events. Timescale for action 19/9/05 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 Good Practice Recommendations None set at this inspection. Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI Hulse Avenue G55_S0000027856_Hulse Avenue_V236861_050705_Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!