CARE HOME ADULTS 18-65
Mount Avenue, 12 12 Mount Avenue Bootle Liverpool Merseyside L20 6DT Lead Inspector
Mrs Janet Marshall Unannounced Inspection 09:00 29th November 2005 & 22 December 2005
nd Mount Avenue, 12 DS0000005226.V271188.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 Mount Avenue, 12 DS0000005226.V271188.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. Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Mount Avenue, 12 Address 12 Mount Avenue Bootle Liverpool Merseyside L20 6DT 0151 944 2134 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) Autism Initiatives Mrs Joan Frances Hazlett Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 3 LD. The service should employ a suitably qualified and experienced manager who is registered with the CSCI. 15th August 2005 Date of last inspection Brief Description of the Service: 12 Mount Avenue is a mid-terraced property situated in a popular residential area of Bootle. The service is operated by Autism Initiatives. The home is located close to all public transport, leisure and shopping facilities.The home is registered as a care home for three adults who have a learning disability.All three residents who currently live in the home are men. The ground floor of the accommodation provides a lounge, dining room, fitted kitchen, toilet/shower room, and upstairs is a bathroom, three large bedrooms and the office/sleep in room. At the rear of the house is a backyard which is attractively paved and furnished for the use of residents. The overall philosophy of care is to enable the residents to live as independently as possible and to promote integration of them into all aspects of life at home and in the community. Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspection visits are required at the home each year, this was the second for the year 2005/2006. The first inspection, which was unannounced, was carried out in August 2005. This was an unannounced inspection lasting for six hours over two days. A partial tour of the home was conducted. Most parts of the home appear to be well maintained. All areas seen were comfortable, clean and tidy. Two residents were at home on both days of the inspection. They were encouraged to continue with their routines and activities as usual. On both days of the inspection staffing levels were appropriate to the needs of the residents. Discussions took place with a number of staff, some of their views and comments have been documented within the report. The nature of the disability of the residents is such that it is not always possible to obtain direct views about their experiences, however, indirect observation of care practice, general observations and compliance with standards provided evidence for a conclusion about the service to be made. A selection of care records and other required records were inspected. Records that were examined included residents care plans, daily records, medical notes, medication sheets, staff rotas and records of health and safety checks. The registration and insurance certificates showing the correct information were displayed at the home. The requirements and recommendations from the last inspection were discussed and examined. All but one requirement given as part of the last inspection has been met, that requirement has been raised again as part of this report. What the service does well:
The service provides residents with a care plan that clearly reflects all their assessed needs. Regular reviewing and updating of the plans ensure that residents care needs are consistently met and that changing needs are identified. Staff were seen encouraging residents to make choices and decisions therefore promoting their independence. They offered and provided the assistance, which is consistent with the resident’s plan of care. The atmosphere in the home is warm and welcoming the residents appeared relaxed and contented. Staff appear to have a good understanding of residents needs they were seen interacting well with them. Staff are good at supporting residents to move freely around the house as part of an independent lifestyle. When staff provide personal support for residents they do it in a way that ensures their privacy and dignity at all times. Care practices observed throughout the inspection show that staff respect the rights, privacy and dignity of residents. The home is comfortable, well maintained and furnished to suit the needs of the residents. Resident’s bedrooms are decorated and furnished to a high
Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 6 standard and reflect their individual lifestyles. Residents are encouraged to display personal items giving the house a more ‘homely’ feel. Indirect observation and discussions with staff show that they are committed to providing a high standard of care at all times. The staff are caring and sensitive to the needs of the residents. The home is run by a manager who is positive and approachable. She has a good understanding of the residents and is knowledgeable about their needs. Comments made by staff about the manager included: “Spot on when it comes to the care of the residents.” “She knows her stuff alright and is very fair as a manager”. What has improved since the last inspection? What they could do better:
A requirement was given at the last inspection for staffing arrangements during the night to be appropriate to the needs of residents. The manager has reviewed the staffing levels and identified that additional staff are required at night to support the changing needs of one resident. The residents funding authority have agreed this, however they have not yet provided the funding to support this. To ensure the health safety and wellbeing of the residents the manager must ensure that staffing levels are appropriate to the needs of the residents. This has been given as a requirement as part of this report. Staff files contained most of the required records to ensure the protection of the residents, however some files do not include a photograph of the staff member which is required as proof of the persons identity. A photograph of each of the persons working at the home must be available in their file, which is kept at the home. This has been given as a requirement as part of this report. During discussions with staff it became apparent that they have not undertaken certain training, which is required of them so that they are appropriately trained to meet the needs of residents. The manager must ensure that all staff undertake training that is appropriate to the work that they are to perform. This has been given as a requirement as part of this report. Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 7 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. Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 8 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 Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 9 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): No standards in this section were examined during this inspection. Standards 1 & 2 were examined at the last inspection and were met. EVIDENCE: Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 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 & 7. met. Standards 6, 9 & 10 were examined at the last inspection and were Residents have a detailed care plan which sets out how their needs and personal goals will be met. Residents are encouraged to make decisions and choices with the assistance that they need, as part of an independent lifestyle. EVIDENCE: Each resident has a care plan which identifies all their needs and how they are met. Care plans cover many aspects of the residents life for example, health and personal care, social needs, behaviour, communication and financial support. Resident’s needs are re-assessed at regular intervals through the homes reviewing process. During reviews changing needs are identified then care plans are updated to reflect any changes. Care plans show the involvement of the resident, their staff, family/representative and other professional agencies. Through discussion and observation staff showed they respect resident’s rights to make decisions. Choices and decisions made for residents by others and why are well recorded in their care plans. For example, none of the residents Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 11 have a key to the front door of the house, the reason for this was recorded in their individual care plans. Protocols and support guidelines, which are consistent with residents care plans provide staff with the information that they need to, help residents make decisions about their own lives. These documents show that they are reviewed and updated at the required intervals. The nature of the disability of residents is such that they are not able to handle their financial affairs. Records show that residents have a bank account in their own name and address. Staff support residents with their finances. Monies and records were examined they are well kept and in good order. Every transaction made is clearly documented and taken account of. Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 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): 16. Standards 12, 13, 15 & 17 were examined at the last inspection and were met. Residents are given choices and are able to move freely around the house as part of an independent lifestyle. EVIDENCE: Both residents were seen using all parts of the home. Staff provided the help and assistance that is required to enable residents move around the home. Information in care files provide staff with clear information about how best to support residents to move about the home freely and safely whilst respecting their right to do so. A good-sized lounge area and dining room, which is separate to the kitchen, provides residents with a good amount of shared and private space apart from their own bedrooms. Staff were seen offering residents with choices and respecting decisions that they made. Mount Avenue, 12 DS0000005226.V271188.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 Standards 19 & 20 was examined at the last inspection and was met. Personal support is carried out in a sensitive and flexible way to ensure the privacy and dignity of residents at all times. Resident’s health care needs are well assessed and understood so that can be appropriately met. EVIDENCE: Staff support residents with personal care. They showed that they provide personal support in a sensitive and flexible way. One member of staff was seen supporting a resident with personal care in the privacy of his own bedroom. Staff were also seen knocking on bedroom doors before entering. The service maintains detailed records of every contact that each resident has with medical and health care professionals. In addition to this, detailed information of the health care agencies involved have been recorded for each resident in their individual plans of care. These records show that all residents receive appropriate health care at the required intervals with the support that they need. Records show that health needs outlined in care plans had been identified and that appropriate contact with social and medical agencies had been met according to the individual needs of residents. Records show that General Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 14 Practitioners had been contacted when health needs changed and that others were involved to re-assess the needs of one resident. Mount Avenue, 12 DS0000005226.V271188.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): 23. Standards 22 & 23 were examined at the last inspection and were met. Standard 23 was assessed again due to findings on the day of the inspection. Staff have not undertaken the required training, which ensures that residents are fully protected from abuse. EVIDENCE: Discussion with a member of staff revealed that they have not undertaken Protection of Vulnerable Adults Training (POVA). All staff must undertake POVA training so that they know what to do if they suspect that abuse is taking place or in the event of an allegation of abuse being made to them. Mount Avenue, 12 DS0000005226.V271188.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): 26. Standards 24, 28 & 30 were examined at the last inspection and were met. Resident’s bedrooms are furnished and personalised to suit their individual needs and lifestyles. Residents live in an environment that is well maintained and well decorated. EVIDENCE: All residents’ bedrooms were looked at. Each room is nicely decorated and well furnished with colour schemes and items chosen by the resident. Pictures, ornaments and other personal items are displayed around resident’s bedrooms. Each resident has a lock on their door and a separate lockable facility for their personal use. Due to the nature of their disability residents are unable to hold a key to their room. The reason for this has been agreed and recorded in resident’s plans of care. Other parts of the home were also looked at. The home has a system for identifying, recording and requesting repairs and replacements, which are carried out by the companies maintenance department. Records show that most requests are dealt with promptly. The home is well decorated and has the feeling of any other domestic style house. Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 17 Domestic style laundry facilities are available in the kitchen separate from the food storage area. All staff are involved in the laundering of residents clothes. Residents are encouraged to help were they are able. The home was noted to be clean and hygienic throughout during the day of the inspection with no offensive odours noted in any area. Mount Avenue, 12 DS0000005226.V271188.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): 33, 34 & 35. Standards 32 & 33 were examined at the last inspection standard 32 was met. Standard 33, which was not fully met, was re-examined at this inspection. Staffing arrangements during the night are not appropriate to meet the needs of residents; this has the potential to put residents and staff at risk. Some procedures for recruitment of staff need to be more robust to provide necessary safeguards and protection for people living in the home. Some staff are not appropriately trained to meet the needs of residents. EVIDENCE: At the last inspection records and discussion with a member of staff showed that the current arrangement of one sleep-in staff during the night is not sufficient in meeting the needs of one resident who is often awake for periods throughout the night, so disturbing other residents and requiring the support of the sleeping member of staff. At this inspection discussion with the manager and records showed that the nighttime staffing arrangements have been reviewed to reflect the changing needs of one resident, however they remain unchanged. The manager explained that extra funding has been agreed in order to support additional staff at night but has not yet ‘come through’. The manager must ensure that the staffing levels are appropriate to the needs of the residents at all times. Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 19 Staff were observed interacting well with residents. They showed that they have good knowledge and understanding of each persons needs and were patient and caring in their approach. Staff responded to residents in a sensitive and flexible manner. During discussion a member of staff said that they are happy with the level of training provided. During discussions with staff it was established that one member of staff who administers medication to residents has not received the appropriate training to do this. All staff that are involved in the administration of medication must undertake the required training prior to carrying out the process. Another member of staff said that they have not undertaken Protection of Vulnerable Adults Training. (POVA). All staff must undertake POVA training so that they know what to do following suspicion or an allegation of abuse. Training records available for staff show that training undertaken focuses on mandatory topics and others that are specific to the needs of the residents. Most training has been provided and reflects the needs of the resident group at present. An induction programme is in place. This takes place during the first part of a person’s employment. Discussion took place with a newly recruited member of staff. He described the induction, which included a host of issues that staff need to know about supporting residents at the home. The induction also included such topics as fire awareness, health and safety and working routines as well as issues centred on the values to be used when supporting residents such as confidentiality and privacy and dignity. A member of staff said the manager carries out regular formal recorded supervision of staff on a one to one basis, records seen in staff files supported this. The member of staff also said that discussions between the manager and other members of the staff team take place daily in the form of handovers, this is in addition to regular staff meeting. Communicating with and the supervision of staff ensure that they are appropriately supported and fully aware of their roles and responsibilities. Staff files that were examined include the required recruitment records such as two references, evidence of CRB check and a fully completed application form. Staff files must also contain proof of the employee’s identity i.e. a photograph of the person. This was not available in some files. The manager must ensure that all staff files include a photograph of the person working at the care home as proof of their identity. Mount Avenue, 12 DS0000005226.V271188.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, 39, 40 & 42. Standards 38, 40 & 42 were examined at the last inspection, standard 32 was met. Standards 40 & 42, which were not fully met, were re-examined at this inspection. Resident’s benefit from receiving a service that is managed by an individual who has good knowledge and experience of their needs. Residents’ are better safeguarded by the homes policies and procedures, which have been reviewed and updated. The required Health and Safety checks have been carried out ensuring the safety of residents and staff. EVIDENCE: The Manager was approved by the Commission for Social Care Inspection in the early part of 2005. Before being appointed as manager Mrs Hazlett worked for some time within the home as a senior support worker so has good knowledge and understanding of the residents and their needs. Staff spoken with during the inspection were nothing but complimentary of the manager and her approach. The overall opinion of the staff is that the manager communicates well, is a good leader and competent and qualified at her job.
Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 21 The quality of the care plans and other records kept at the home also supported this. One member of staff described the manager as being ‘spot on when it comes to the care of the residents.’ Another said, ‘she knows her stuff alright and is very fair as a manager’. Records show that a representative for the company visits the home monthly, to interview residents and staff and inspect the premises. This is done so that the person can check records and form an opinion of the standard of care in the home and also to seek the views of the people who live there. Following the visit the representative writes a report a copy of which is sent to the Commission. Certificates were available to show that all staff have completed health and safety training, however there are some areas of training, which have not been undertaken by staff, as described in standards This compromises the welfare and safety of residents. At the last inspection records showed that small appliances used in the home had not been P.A.T tested since May 2004, a requirement was given for this, as they must be tested annually to ensure that they are safe to use. At this inspection records showed that all small appliances have since been tested for their safety. Also at the last inspection a number of the homes policies and procedures (P&P) showed that they had not been reviewed for some time so it was not clear as to whether they remain relevant. The handbook containing the homes policies and procedures was examined, it shows that a number of documents have been reviewed and were necessary, updated. The manager said that the company are in the process of reviewing other (P&P) for the home. Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X 3 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 2 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Mount Avenue, 12 Score 3 4 X X Standard No 37 38 39 40 41 42 43 Score 3 X 3 3 X 3 X DS0000005226.V271188.R01.S.doc Version 5.0 Page 23 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 2 3 Standard YA34 YA35 YA33 Regulation Requirement Timescale for action 31/01/06 28/02/06 31/01/06 19(4)(b)(i) Staff files must include proof of the person’s identity. 18(1)(i) All staff must receive training appropriate to the work that they perform. 18(1a) Staffing arrangements at night must meet the needs of residents. 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 Mount Avenue, 12 DS0000005226.V271188.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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