Inspection on 01/11/05 for Mildred Avenue

This inspection was carried out on 1st November 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mildred Avenue 25/06/07

Mildred Avenue 04/07/06

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Mildred Avenue 136 Mildred Avenue Watford Hertfordshire WD18 7DX Lead Inspector Mrs Jan Sheppard Unannounced Inspection 1st November 2005 10:00 Mildred Avenue DS0000065462.V263597.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 Mildred Avenue DS0000065462.V263597.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. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Mildred Avenue Address 136 Mildred Avenue Watford Hertfordshire WD18 7DX 01923 249048 01923 249243 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) CareTech Community Services (No.2) Ltd Mrs Siobhan Vercesi Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 09/05/2005 Brief Description of the Service: Mildred Avenue is a two storey detached property on a corner plot with a garden to the front and rear. It is conveniently positioned being within walking distance of Watford town centre and is well placed for access to major road and rail routes. The home provides single bedrooms for all of its six residents, two having en-suite facilities. On the ground floor there is an entrance lobby, lounge and dining room with level access to the garden, the kitchen a bathroom and two bedrooms. There are stairs to the first floor, which comprises another bathroom and separate toilet, an office, the laundry room and three further single bedrooms. The home, which is owned by Caretech Community Services Ltd. provides homely accommodation for six service users with learning disabilities. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection of this inspection year and took place over one day during which the deputy manager and all other staff on duty were spoken with. Three of the residents were also met, the inspector spoke at length with one and observed and interacted with the others, who both have very limited speech. Time was spent looking at the care plans and other records maintained by the home. A tour was made of the building and gardens. Since the last inspection one of the residents has left the home and the registered manager has taken maternity leave and her place has been taken in an acting capacity by the deputy manager. The requirements made during the last inspection have been met or have work ongoing. This was a positive inspection. The home was found to have a very relaxed atmosphere and a homely appearance. The residents appeared to be happy they were stimulated and occupied and were obviously very at ease with the staff and “at-home” in their own personal spaces. What the service does well: What has improved since the last inspection? What they could do better: Works to further improve the appearance and user friendliness of the garden should be continued with in readiness for next summer. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 6 As the majority of the residents enjoy watching TV consideration should be given to enabling them to have more choices by possibly providing Sky TV channels. 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. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 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 Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 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. Appropriate information is available for prospective service users concerning how the home operates and what procedures are in place to meet their care needs and aspirations. EVIDENCE: The home has a pre-admission policy and procedure that meets the requirements of this standard. These procedures were seen to have been followed for one new resident who had been admitted to the home since the last inspection. The new resident confirmed that he had been given plenty of opportunity to visit the home and to get to know the other residents as part of his initial introduction and that one of these visits had included an over night stay. He told the inspector that his Mum and step Dad had also visited the home and that he now felt settled and very happy in the home. He showed the inspector the various features of his room that he had changed and discussed plans that he had for further improvements. The contract statement of Terms and Conditions given to every new service user gives details of their room, the fees payable, the care and services that they will receive and the terms and conditions of their occupancy including their rights and obligations in the event of any breach of contract. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 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): 6,7,8,9 and 10. Comprehensive care plans are maintained which contain very detailed person centred descriptions as to how care needs should be met these to meet with the wishes and desires of each individual resident. Detailed risk assessments are also maintained and both these and the care plans are regularly reviewed. EVIDENCE: Four of the care plans were examined and these were found to be well organised and to give clear and concise instructions as to how care should be delivered. The detail in one plan for a resident whose needs are fluctuating, was found to be following the suggestions made at a recent multi disciplinary review meeting. Where possible families or friends are involved in these review meetings when risk assessments were also reconsidered and degrees of acceptable risk identified. All the care plans examined were found to have been subject to regular reviews and the manager was able to demonstrate the dates when future reviews had been planned. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 10 The manager discussed with the inspector the manner in which the degree of risk associated for one resident who is able to go out to some local venues unaccompanied was assessed and the steps that had been taken to ensure that he was fully trained and prepared for these journeys. The records relating to the residents meetings evidenced that they are involved in as many of the decision making processes concerning the running of their home as it is safely possible for them to so be. The information about the service users was found to be appropriately and securely kept and that staff had a good awareness of the keeping of confidences and of not talking in such a manner that they may be over heard in this small home setting. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 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): 12,14,15 and 17 The residents all have day activity programmes, which give them the opportunity for personal development alongside peers of a similar age and ability. Activities and classes are chosen to meet the residents interests and where appropriate to enable them to achieve realistic personal development goals the home also organises a monthly evening and weekend activity programme details of this seen displayed on the notice board. The residents maintain close relations with friends and relatives to whom some are able to make day and staying visits. A nutritious and varied menu chosen by the residents and supervised by a dietician is offered with fresh ingredients and home cooking being provided on a daily basis. EVIDENCE: All the residents have day centre activity programmes covering between two and four days each week with the number of days and the activities chosen to meet their individual interests and abilities and also to help them to maintain and develop further their daily living skills. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 12 The declining abilities of one resident and the need to re-plan his programme so that it more appropriately meets his current abilities were discussed with the inspector. The weekend and evening activity programme is arranged on a monthly basis and the records of the most recent residents meeting, (14/10/05) evidenced that plans had been made to facilitate the requests of two individual residents to take part in Halloween activities and to attend a Guy Fawkes Fireworks Party. Discussions about future Christmas outings and the joining in with seasonal activities in their local community could also be evidenced. There have been no changes to the menu arrangements since the last inspection. The home continues to follow a healthy eating diet regime and a good selection of fresh meat; fruit and vegetables were seen in the refrigerator. Residents were seen to have free access to fresh fruit and yogurts. The most recently admitted resident told the inspector that there is always plenty to eat and confirmed that good choices were always available. He said that sometimes he helps the staff with the weekly shopping and that he is also able to assist with the cooking if he wishes. He also told the inspector of his recent discussions with the dietician and of his efforts to keep to his own particular planned diet. All the residents who were fit enough to do so and who wished to do so were enabled to take a staying away holiday during the past summer months. The photographs evidenced that visits to Tunisia, Scotland, and Denmark and on a country farm holiday were enjoyed by the residents either individually or in pairs according to their choice. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 13 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): 18,19,20 and 21. The personal care and health care offered to the residents is of a high standard and is well personalised to meet their individual needs and takes account of their wishes and preferences. The home has a sound medication storage and administration procedure and only trained staff administer the medication. A controlled drugs cupboard and administration register are required. EVIDENCE: Individual personal care practice observed was good, staff were seen to be offering the residents choices and to be managing their care needs at a pace with which the individual resident was comfortable. Many of the staff have worked with these residents for some years and have an in-depth understanding of their care needs and of their varying needs and can interpret their wishes as to how these needs should best be met. The home continues to maintain close professional working relationships with their GP, the community nursing team, the psychologist and with various specialist hospital Consultants whose input into the recent care review meetings was seen to be very detailed. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 14 The records demonstrated that the recent changing care needs of several of the residents had been reviewed promptly with the appropriate referrals made for hospital consultations and that reviews of these and their need for further treatments were also planned. The funeral and after life arrangements for the residents were, where these could be discussed with their families, recorded on their care plans. One resident with an understanding of these matters had signed his own plans making his wishes clearly known. The staff discussed with the inspector how they recently supported and accompanied one resident to attend the funeral of a parent where he had also met up with relatives whom he had not seen for many years. The home continues to use the Boots MDS, monitored dosage medication system. The medication was found to be properly stored and the MAR sheets accurately recorded .All staff who administer medication have received the appropriate training to do so and no inaccuracies were found on the MAR sheets. To fully meet this standard the home is required to have a controlled drugs cupboard and register and to store all medication not contained in blister packs in separate named containers one for each resident. Mildred Avenue DS0000065462.V263597.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): 22 and 23 The home has a complaints policy and procedure a copy of which has been given to all the service users and to their families. The home has policies and procedures concerning Adult Protection and Whistle Blowing, which follow the guidelines given in the Hertfordshire Adult Protection Joint Agency procedures. EVIDENCE: There have been no complaints nor any incidents concerning Adult Abuse since the last inspection. Staff spoken with demonstrated a good awareness of Adult Protection and of Whistle Blowing. The homes records demonstrated that all staff had attended training on these subjects. The recently admitted new resident had a good understanding of the Complaints policy and told the inspector that if he had any complaints he would not be afraid to voice these. Mildred Avenue DS0000065462.V263597.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 and 30 The home is extremely comfortable and has a homely appearance and feel. It provides accommodation that meets the needs of the current residents. The building fits unobtrusively into the community in which it is set. The use of wedges to hold open fire doors compromises the safety of the home. Works to improve the appearance of the rear garden, commenced during the summer months, must be completed. EVIDENCE: The home, which is an adapted and extended Edwardian house, was first renovated into a care home in the mid 1990s. It provides single bedrooms for all its residents some being extremely spacious and two having en-suite facilities. The home is well appointed with attractive decorations and is subject to a routine maintenance programme. Since the last inspection works of redecoration have been carried out in some bedrooms, in a bathroom and in the lounge, hallway, stairs and landing and some of these areas have also been re-carpeted. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 17 On the day of this inspection the use of door wedges to hold open certain fire doors compromised the safety of the home; these wedges were removed during the inspection. The rear garden had been subject to various works of improvement and replanting over the summer months and it is recommended that these works are completed so that the garden and patio can provide an attractive area to be used by the residents during the warmer months. Mildred Avenue DS0000065462.V263597.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): 32,34 and 35 The home is run by dedicated and experienced staff who work well together as a team and are enthusiastic about their work. The staffing levels are adequate and staff have appropriate skills to meet the current residents needs. The home has robust recruitment policies and procedures to ensure the necessary protection and safety for the residents. EVIDENCE: Without exception the staff spoke very positively about their work at Mildred Avenue and about the training opportunities that are afforded them by the company. All the current staff have either already attained the NVQ level 2 qualification or are studying for this. (56 have attained level 2.) and several others are studying for level 3. The manager, currently taking maternity leave has NVQ level 4 and the Registered Managers Award and the Deputy Manager, currently acting into the managers role has NVQ level 2 and is to commence level 4 in the new year. The records evidenced that all the staff receive monthly supervision and an annual appraisal. Staff also have an individual training needs profile compiled on an annual basis and the records demonstrated that regular training is undertaken in keeping with these objectives and plans. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 19 The available records concerning a recent recruitment drive demonstrated that the appropriate documents, records and checks had been taken up these to ensure that the safety of the residents is protected. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 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 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 and 42 The home is well run by calm and confident staff who ensure that the safety of the residents is not compromised whilst allowing them to have as much autonomy over their own lives, as it is safely possible for them so to do. The residents health and safety were seen to be promoted with one exception. (missing paper towel holder). EVIDENCE: On the day of this unannounced inspection the home was found to be calm and settled and the residents happy to speak with, or in their own ways to communicate with, the inspector and then to just get on with what ever they were doing. The acting manager was seen to have fitted into her new role and was giving leadership as required. Health and safety issues were found to be being given priority by all the staff and this provides a warm and caring environment for the residents who seemed relaxed and happy. A replacement paper towel holder is required in the first floor toilet this to promote infection control at all times and to ensure the health and safety of the residents. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 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 Score 3 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 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 x 14 3 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 x x 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mildred Avenue Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x DS0000065462.V263597.R01.S.doc Version 5.0 Page 22 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 Standard YA20 Regulation 13 (2) Requirement A controlled drugs cupboard and a controlled drugs register must be provided and suitably installed to meet with the requirements of the Royal Pharmaceutical Society. Medication not dispensed in blister packs should be stored in separated named containers, one for each resident. A paper towel holder is required in the upstairs toilet this to ensure the good maintenance of infection control for all the residents. To comply with the Fire Safety measures door wedges must never be used, as these put the safety of the home, residents and staff at risk. (All door wedges were removed during this inspection) Timescale for action 30/11/05 2 YA42 13 (3) 30/11/05 3 YA24 13(4)(a)& 23(4) 01/11/05 Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 23 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 YA24 Good Practice Recommendations It is recommended that the works to improve the rear garden (already commenced) are completed. Mildred Avenue DS0000065462.V263597.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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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