Inspection on 04/07/06 for Mildred Avenue

This inspection was carried out on 4th July 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

Mildred Avenue 25/06/07

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 Hazel Wynn Key Unannounced Inspection 4th July 2006 10:00 Mildred Avenue DS0000065462.V302078.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.V302078.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.V302078.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 Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 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 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). Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the outcomes of the unannounced inspection carried out by one regulation inspector representing CSCI on 4th July 2006 using available evidence gathered, since the last key inspection, during this visit including observation, discussion with residents, care staff and the manager and examination of records maintained in the home. All of the key standards were assessed during this inspection and the overall outcome was very positive. Requirements and a recommendation made at the last inspection had been actioned/met. All residents spoken with expressed being happy living at the home, and said they liked the staff. Evidence was provided activities that suited individual needs, wishes and abilities are available. There is a new manager was in post and her application for registration is in process; the new manager demonstrated that she has a good ethos and portrayed confidence and competence. Medication, recruitment, cares plans and health and safety records were sampled during the inspection and found to be accurately and meticulously recorded. Based on this inspection visit and information received since the last inspection visit, the overall quality of this service is good. What the service does well: The home provides a service that is run in the best interests of the residents and provides a warm, friendly and homely atmosphere. Individual programmes of care are well monitored and reviews are kept up to date. A good lifestyle is provided for residents. A reliable quality assurance system is in place and continuous auditing is carried out. The care staff demonstrated a sound understanding of individual needs and were observed to be very supportive of the residents both individually and collectively. There was a lot of fun and laughter portraying a happy domestic setting. The home provides a healthy varied diet, which is monitored by the dietician on a monthly basis. Health and safety protocols are in place. Recruitment is robust and a rolling programme of staff training is provided. Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 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. Mildred Avenue DS0000065462.V302078.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.V302078.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 The appropriate information is available in order for prospective residents to make a choice about where to live and concerning how the home operates; including a description about the systems in place to meet their care needs and aspirations. Visits and “test drives” to the home are supported. A copy of the individual contact/terms and conditions is provided to each resident. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose that meets the standard and an explanative service users guide, which is provided to prospective residents. A pre-admission policy and procedure is in place at the home and this meets the requirements of this standard. Two prospective residents were recently assessed within the guidelines of the policy and procedure and found not to meet the criteria; this provided evidence that the systems in place had been followed. At the last inspection a 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. The visits and overnight stay form part of the assessment process in gathering information in relation to health, social and personal needs and goals. During this inspection the same resident confirmed that he was still very happy living at the home and his parents are happy; he Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 Page 9 stated he was well looked after; his file provided evidence that his needs are clearly stated and met. The contract statement of Terms and Conditions given to every new service user showed 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.V302078.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 Comprehensive care plans are maintained containing detailed person centred descriptions as to how care needs should be met and to meet with the wishes and desires of residents. Detailed risk assessments are also maintained and both these and the care plans are regularly reviewed. Residents are supported to take risks within a risk management framework. Residents are supported to make decisions about their lives and are involved with making decisions in relation to the running of the home. All personal information is securely stored and staff are provided with training in confidentiality. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Three care plans were explored; these were well organised and gave clear guidance to care staff to enable safe and consistent care. There is a multi disciplinary approach to drawing up the care plans and reviews and this is evidenced on file. The individual residents and their relatives (where appropriate or possible) are involved in the care plan and review process. The manager provided evidence that the care plans had been reviewed in May Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 Page 11 2006 and are reviewed twice yearly (the manager explained that this would be sooner where there is an unexpected change). One service user is able to go out unaccompanied in and around the local community; his care plan file showed that a comprehensive risk assessment has been carried out and training provided to minimise any risks to him. He has continued to manage independently for some time and spoke proudly of his independence. Residents meetings take place regularly and are minuted and these records provide evidence that they are involved in as many of the decision-making processes concerning the running of their home to their fullest potential. The information about the residents was observed to be appropriately and securely stored and staff demonstrated 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.V302078.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 - 17 The opportunity for personal development alongside peers of a similar age and ability is provided. Planned activities ensure the residents are part of their local community. The residents maintain close relations with friends and relatives to whom some are able to make day and staying visits. Residents’ rights and responsibilities are recognised. A nutritious and varied menu chosen by the residents is provided at suitable and flexible times and in a comfortable setting. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The residents all have day activity programmes (evidence was available in the individual care plans), which provides the opportunity for personal development alongside peers of a similar age and ability. Activities and classes are selected to meet the residents’ interests and where appropriate to enable them to achieve realistic personal development goals. The monthly activities programme demonstrates how the residents are supported to enjoy appropriate community resources and also to belong within a church congregation if desired. One of the residents said he likes to go to church and the staff go with him; the staff explained that one of the staff on duty is Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 Page 13 assigned to support him. Some of the residents are able to maintain close ties with their relatives and friends and make visits/stays on a regular basis. One of the residents explained that he was going on a two-week holiday with his mother to Disney Land, Orlando, USA, very shortly. Staff explained that one of the resident’s mothers died last year and now has no other family member who wishes to maintain contact. Some of the residents (and in particular one) was very clear about his rights and responsibilities and those of others. The contract/agreement is explanative and explains the service that will be provided and the rights and responsibilities of the individual resident. 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. The dietician, who visits monthly, arrived for a meeting with staff and residents during the inspection. Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 - 20 Personal support is provided in the way individual residents prefer. The residents physical and emotional needs are met. The residents are supported with medication in an appropriate and safe manner in accordance with policy and procedure. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Three care plans were explored; these were well organised and gave clear guidance to care staff to enable safe and consistent care and in the manner preferred by the individual resident. The care plans show how physical and emotional needs are to be met and progress notes support the evidence of needs met. One to one sessions help to support residents with emotional needs. The residents have general and specific health care needs and the records show how these are met on an individual basis. All of the residents attend a well-women’s or well-men’s clinic at their local GP service. A member of staff was observed to be providing reassurance to one of the residents. The residents are supported to manage their medication needs as is appropriate and policies and procedures are in place to provide safeguards. A check of the system provided evidence of good management and this is audited by the home on a regular basis. Mildred Avenue DS0000065462.V302078.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Residents’ views are listened to and acted on and service uses are protected from abuse, neglect and self-harm. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: In March of this year the home provided the outcome of an investigation into a resident’s complaint and this had been resolved to the resident’s satisfaction. No further complaints have been received by the home. Care staff were able to demonstrate their awareness of procedures and guidelines in place to protect the residents from abuse, neglect or self-harm. Training in abuse awareness and the whistle blowing procedures are provided during induction and at regular updates as observed on the training planner and as confirmed by staff. Risk assessments were in place to minimise risk of harm. Financial procedures were sampled and management of individual residents financial records were observed to be transparent. Mildred Avenue DS0000065462.V302078.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 and 30 The home is very comfortable and homely. The accommodation meets the needs of the current residents. Resident’s own rooms have been decorated and personalised to their own preference and promote independence. The home was fresh, clean and hygienic. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: When touring the building the inspector observed it to be well decorated and maintained; the home was fresh, clean, hygienic, comfortably and attractively furnished throughout. To ensure safety of staff and residents portable electrical appliance checks had been carried out on 3rd July 06. Every month staff carry out a visual check and the record of this was seen. The weekly testing of water temperatures was also seen and water was being maintained at a temperature of close to 43°C to prevent accidental scalding. A lot of effort had gone into improving the garden – the resident and staff were finding the recent drought and watering ban difficult and struggling to keep the newly planted bedding plants and the grass watered sufficiently. The fire records provided evidence that regular checks and drills are in place and that servicing of the Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 Page 17 fire safety equipment is carried out on a contractual basis to ensure continued safety of all within the home. Mildred Avenue DS0000065462.V302078.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 - 36 The staff on duty were observed to work as part of a team to support the residents. They demonstrated that they were aware of the their roles and responsibilities. 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. The staff are appropriately trained and supervised to meet joint and individual needs of the residents. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: All the current staff have either already attained the NVQ level 2 qualification or are working towards this. The most recent recruit was on duty and showed the inspector her ‘Bild’ foundation course booklet, which she is working through, having just completed her induction programme. A new manager is in place and her registration application is in process and she is in the process of working towards level 4 NVQ registered managers award. The records evidenced that all the staff receive monthly supervision and an annual appraisal and the staff on duty confirmed this takes place. There were adequate staff on duty and the rota reflected that these levels are maintained. Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 Page 19 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. Two staff recruited since the last inspection had evidence on the files examined during this inspection that robust methods had been applied in their recruitment; the appropriate documents, records and checks had been taken up these to ensure that the safety of the residents is protected. The staff spoken to were able to demonstrate their thorough knowledge of the resident’s need as a group and individually. Mildred Avenue DS0000065462.V302078.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 The home is well run by a competent staff team. The staff demonstrate a good ethos and are happy with the leadership and management they experience. The residents are confident that they are listened to and that their views are incorporated into the progress made by the home. The competent and accountable management of the service benefits the residents. There is no compromise on the health safety and welfare of the residents or staff team. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The new manager was observed to have fitted into her new role and was providing competent leadership. Various records were perused as part of the inspection as reported earlier and these were observed to be well maintained with good audit systems and records of these in place. The new manager is in the process of her application for registration. On the day of this unannounced inspection the residents were relaxed and happy to speak with the inspector and to relay all the good things in their lives and the holidays they had Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 Page 21 planned. They had answered the door and sought identity and clarification of that before letting the inspector in. Health and safety systems were observed to be well managed with records to evidence the checks and actions taken. From records examined evidence was obtained that robust recruitment procedures are maintained (see under staffing where further detail is provided). Mildred Avenue DS0000065462.V302078.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 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 x 28 x 29 x 30 3 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 3 3 3 3 3 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 3 3 3 X 3 3 3 X X 3 X Mildred Avenue DS0000065462.V302078.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. Refer to Standard Good Practice Recommendations Mildred Avenue DS0000065462.V302078.R01.S.doc Version 5.2 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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