Inspection on 25/06/07 for Mildred Avenue

This inspection was carried out on 25th June 2007.

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

Mildred Avenue 04/07/06

Mildred Avenue 01/11/05

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 25th June 2007 10:00 Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 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.V344651.R01.S.doc Version 5.2 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.V344651.R01.S.doc Version 5.2 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 Miss Zeenat Aman Domah Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2006 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 residents with learning disabilities. The fee range is currently £907.00 - £1316.34 and reflects assessed level of need (the fee range stated covers the fees charged for the current residents). Information regarding the service is available in the Statement of Purpose and Service User Guide, which are freely available from the manager as is a copy of the latest CSCI inspection report. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day when all the residents, and all the staff on duty were spoken with and in depth discussions were held with the manager. A tour of the building and gardens was also made. The comments in this report reflect the findings made by the inspector during that visit and also take account any information gathered over the past months from the manager and by way of pre-inspection questionnaires completed by all the residents and by a number of relatives and other stakeholders in the home. This was a positive inspection with the majority of the key standards examined being met. One recommendation is made to further improve practice following this inspection. During the period of this visit the residents who appeared to be well cared for all seemed very happy and relaxed. The manager’s application for registration by the Commission was accepted in November 2006. What the service does well: What has improved since the last inspection? Since the last inspection a number of improvements have been made to the environment with areas of redecoration and new furnishings provided in the lounge and dining room. Work in the garden has produced a well-tended appearance with colourful flowerbeds for people who use the service to enjoy. A larger medication cupboard has been obtained into which a controlled drugs facility has been fitted. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 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.V344651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People who use this service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to the service. People who use the service can be assured that admissions are not agreed until a full needs assessment has been carried out and the manager is satisfied that the home can meet these needs and that the prospective resident will be compatible with the existing small resident group. Sufficient information is provided for prospective residents and their families to enable them to make an informed choice about admission. EVIDENCE: The care records for the one new resident admitted since the last inspection evidenced that a full needs assessment had been carried out by the manager prior to them being invited to visit the home. A number of visits of increasing duration were then made leading to a staying over night visit. The new resident told the inspector that she was happy in the home and staff confirmed that she had settled in very quickly. All residents are provided with a statement of purpose and service users guide. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use this service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to the service. Good care plans are maintained for each resident with guidance to staff how to meet each persons needs. Appropriate procedures are in place to ensure the safety of the people using this service both inside and outside of the home. The residents are given encouragement to make as many decisions about their own lives as it is safely possible for them to do. EVIDENCE: The care plans examined were all very well maintained following a clear person centred planning (PCP) format. Good descriptions as to individual care needs were recorded along with suggested or proven methods of communication (given that none of the residents have very much speech) to meet the known Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 10 wishes and likes of each resident. The Care plans were regularly reviewed and evidence of the service users involvement with these reviews by way of their mark or signature could also be seen. A statement for each resident concerning their after death wishes and arrangements were seen to be recorded on each plan. Risk assessments to meet individuals changing needs were regularly updated. Helpful suggestions as to how certain known difficult situations might be handled to minimise risk were recorded. The risks, which could apply to the one resident who is able to leave the home unaccompanied to visit the local shop, were seen to have been carefully assessed. The records of the residents’ meetings evidenced that staff make every effort to involve them in decisions concerning the running of Mildred Avenue and the life style and activities that they follow. In addition to this group meeting, each resident has a regular individual meetings with their key worker during which the recent compiling of the visual ‘My Health Plan’ evidenced very good consultation covering every area . The social diary section was seen to cover Outings and Life and Leisure experiences and plans, with comments such as “ Have my eyebrows shaped one a month……nice “ and….” go to the garden centre to buy plants for the summer “ Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. People who use this service experience good quality outcomes in this area. This judgement has been reached using a range of evidence including a visit to this service. The people who use the service attend a varied day activity and educational programme planned to meet their individual needs. Support in accessing a range of evening and weekend community facilities to enhance the lives of the residents is provided. A varied and healthy diet of freshly prepared good quality food is provided. EVIDENCE: The quality of this outcome area has been maintained with some improvements made since the last inspection when these standards were met with no requirements made. All the residents have individually planned social and activity plans which were well recorded as part of their person centred Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 12 care plans. It was noted that these plans are also regularly reviewed to take account of any changing needs or wishes. Each residents plans encompass three or four days attendance at either a local day centre or college class as well as some regular evening and weekend activities involving sport or community events. On the day of this inspection one resident was taken swimming and the records evidenced that others regularly swim or attend the gym at weekends. The manager discussed with the inspector the homes efforts to maintain an awareness of the need for a healthy lifestyle and said that to further this several residents now regularly went out walking. Another resident is regularly taken to attend a Sunday church service and two others like to go to local football matches. A nails and message group held usually at weekends is also very popular. Some of the residents discussed their plans for summer holidays. One resident who had returned from a Norfolk holiday the day prior to this inspection shared the sweets that they had bought with staff and residents. Holiday brochures were shown to the inspector; the manager explained that last years destinations included Italy, Ireland, France and Turkey as well as UK locations and a number of happy holiday photos were seen. Preparations for the weekly food-shopping outing were being finalised during this inspection and the lists evidenced that fresh fruit, vegetables and low fat items are regularly bought and that food is freshly prepared on a daily basis. Ready meals are rarely used although take away meals remain popular. The manager commented on how the residents choose the weekly menu, and that choices had changed with far less fried food now being requested but with curries and spicy food becoming more popular. One resident on returning home from their day activities was offered a cup of tea and biscuit but chose instead to have an apple. The weight of each resident is regularly recorded. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People who use this service experience good quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to the service. Personal Care and Health Care offered to the residents continues to be of a high standard. A robust, well maintained, medication storage and administration system is in place to protect the people who use the service. EVIDENCE: A robust medication storage and administration system is in place to which there have been no changes since the last inspection. All staff who administer medication have been trained to do so. The recordings on the MAR (medication administration record) sheets were properly made with no omissions. The manager said that she carries out regular audits of this system. She discussed with the inspector the arrangements that are in place for one Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 14 resident who regularly goes home to stay with their family during which time they administer their own medication. Staff were seen to patiently support each resident when they returned to the home from their various day activities. Each was assisted to get a tea time snack of their choosing and were then enabled to go wherever in the home they wished to eat this, some choose to be alone in their rooms others sat together in the lounge. Their individual patterns were clearly well known to the staff who assisted them with their choices. It was seen that the resident’s physical and emotional needs were being adequately met and that a happy and relaxed atmosphere existed in the home. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use this service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to the service. Policies and procedures are in place concerning complaints and the protection of adults that should safeguard the residents. The format for Adult protection follows the Hertfordshire Joint Agency Guidelines. Resident’s views are regularly asked for, listened to and when ever possible acted upon. EVIDENCE: A comprehensive complaints policy and procedure is in place and is well published to both resident and to those responsible for them. No complaints have been received since the last inspection. One complimentary letter from a relative was shown to the inspector. Staff receive training in issues and procedures around the protection of vulnerable adults. Since the last inspection the manager could evidence that one incident had been properly handled by her to ensure the safety of the residents concerned and this situation is still the subject of joint agency investigations. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use this service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to the service. The physical design and layout of the home enables the residents to live in a safe, generally well-maintained and comfortable environment, which encourages their independence. However, some improvements to maintenance and cleanliness could be made for the benefit of the people who live in the home. EVIDENCE: The home is essentially domestic in scale but offers good-sized accommodation, which provides a comfortable and safe environment for its residents. Since the last inspection several areas have been redecorated and new furnishings, leather sofas for the lounge and new dining table and chairs Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 17 along with a new television, all items chosen by the residents, have improved the appearance of these communal areas. Several of the residents showed the inspector their rooms and one exercised their choice in refusing to do this. These individual bedrooms were found to be well personalised in a manner that reflected each residents taste and interests. Appropriate pictures, ornaments and electrical lighting, DVD and musical equipment was seen in the rooms. Although generally the homes attractive decorations are maintained to a good standard areas of the stairs and landing had marked and chipped paintwork and are in need of attention to maintain the good overall decorative appearance of the home. The kitchen had flaking paint and an area of crumbling plaster on one wall and several marked areas on the ceiling. The inspector found dusty walls, and caked grease and dust on the cooker hood which could pose a health hazard. The need for regular deep cleaning of the kitchen was discussed with the Manager. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. People who use this service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to the service. Appropriate numbers of appropriately trained and skilled are employed to support the people who use the service and to ensure the smooth running of the home. The recruitment practices are robust thereby offering protection to the service users. EVIDENCE: Mildred Avenue has a stable core group of staff several of whom have worked at the home for some years and have therefore got to know the residents and to understand how to meet their care needs well. Two staff posts that are currently not filled with permanent appointments are in process of being readvertised as previous advertisements have not resulted in any suitable applicants. Using regular staff from the Care Tech relief pool, ensuring continuity of care for the residents, covers these vacancies. The manager is aware of the importance of only appointing suitably qualified or experienced Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 19 staff who will fit in with the existing staff group and who are of sufficient calibre to maintain the good standards of care for these vulnerable residents. There were adequate staff on duty on the day of this inspection to maintain the smooth running of the home and the staff rotas reflected that these levels are maintained. The manager discussed with the inspector the difficulties of ensuring that some permanent staff covers all hours whilst these vacancies exist. All the current staff have either already attained NVQ at level 2 or are working towards this and several have also studied for level 3. Staff were keen to extend their training and mentioned a number of courses that had been accessed since the last inspection including Medication Administration, Epilepsy, Autism, Dementia and Adult Protection training. All the staff have completed a ‘signing training’ although no residents currently use this formal system. The staff team building exercise day had recently been held for all the staff. The records evidenced that staff receive monthly supervision and an annual appraisal and staff spoken with confirmed this. The records relating to staff recruited since the last inspection evidenced that this process had been thoroughly carried out with the required checks made and copies of supporting documents seen on file. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People who use this service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to the service. People using this service are safeguarded by a clear management approach used by the suitably experienced new manager. The open management approach encourages resident’s independence and choices. The safety of the residents is supported by the good maintenance of the homes records. A satisfactory system of quality assurance in place to ensure that the views of the people who use the service are obtained. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 21 EVIDENCE: The new manager has, since the last inspection, been registered by the Commission. She is completing her studies for NVQ level 4 Registered Managers Award. The residents clearly had good rapport and confidence in her, everyone of them on returning from their day activities made their way to speak with her about the various activities of their day. All the residents seemed relaxed and happy and most shared with the inspector about their lives, some showed their rooms and others mentioned their holiday aspirations and food choices. The service users despite their limited verbal abilities are quite able to make their views and wishes known and these were seen to underpin the running of the home. One resident on returning home from their day activity was heard to negotiate for themselves a change to their planned evening meal whilst another who was offered by staff to participate in an out of home shopping activity declined in favour of chilling in their room to watch TV. Health and safety systems were well managed and the spot checks made of these (fire testing, water temperature and accident reporting) during this inspection evidenced that they were well maintained. The manager told the inspector of the recent efforts she had made to raise the resident’s level of awareness of the need for fire safety procedures. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 23 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 YA30 Good Practice Recommendations The whole of the home should be kept in good decorative order and that a good standard of cleanliness in the kitchen and equipment is maintained. Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Mildred Avenue DS0000065462.V344651.R01.S.doc Version 5.2 Page 25 - 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. 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