Inspection on 27/09/07 for Norwood 60 Carlton Avenue

This inspection was carried out on 27th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Norwood 60 Carlton Avenue 27/09/06

Norwood 60 Carlton Avenue 03/01/06

Norwood 60 Carlton Avenue 05/09/05

Norwood 60 Carlton Avenue 25/01/05

Norwood 60 Carlton Avenue 13/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Norwood 60 Carlton Avenue 60 Carlton Avenue Kenton Middlesex HA3 8AY Lead Inspector Judith Brindle Key Unannounced Inspection 27th September 2007 08:30 Norwood 60 Carlton Avenue DS0000017520.V344031.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 Norwood 60 Carlton Avenue DS0000017520.V344031.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. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norwood 60 Carlton Avenue Address 60 Carlton Avenue Kenton Middlesex HA3 8AY 020 8907 0239 020 8907 3711 carltonavenue@norwood.org.uk www.norwood.org.uk Norwood 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) Ms Amy Vickers Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2006 Brief Description of the Service: 60 Carlton Avenue is a care home providing personal care, and accommodation for up to 8 adults with learning disabilities. The care home is owned by Norwood, which is a Jewish organisation that provides care for children and adults with learning disabilities. The care home is located in a residential street in Kenton, close to Harrow. The home is situated very close to a park. There are local shops, a large supermarket, pubs, a post office, building societies, restaurants, and other amenities within a few minutes walk from the home. Local bus and train public transport facilities are located nearby. The home was opened in 1997, and consists of a purpose built detached building. There is a small garden area, and parking for 2-3 vehicles at the front of the house. The home includes a flat attached to the main house, where accommodation and support is provided for up to two residents, to enable them to have the opportunity to develop independent living skills. All the homes bedrooms are single; one bedroom has a shower facility. The home has a passenger lift. There is an enclosed, accessible, maintained garden at the rear of the property. Documentation/information about the care home is accessible to residents and visitors. Fees, including additional charges vary according to the individual needs of residents, and are recorded in the resident’s written terms and conditions/contracts. Details of fees can be obtained from the owner. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place throughout a day in September 2007. There were no vacancies at the time of the inspection. During the inspection I was pleased to meet with all except one resident (who was on holiday during the inspection). Most of the people using the service have limited vocal communication abilities and are able to respond to questions to a limited degree. Therefore observation was an important tool used during the inspection. Prior to this unannounced key inspection the registered manager supplied the Commission for Social Care Inspection a completed Annual Quality Assurance Assessment (AQAA) document. This document included required information from the registered manager about the quality of the care home and of the plans to continue to improve the service. All sections of this document were comprehensively completed. Reference to some aspects of this AQAA record will be documented in this report. Staff were also spoken with during the inspection and all were very helpful in supplying documentation, and information requested by the inspector. The registered manager was present during the inspection. Due to the multiple needs (including communication needs) of the residents, the inspection focussed on spending a significant period of the inspection in the communal areas of the care home observing interaction between residents and staff. Talking with a resident about their experience of living in the home was also an important part of the inspection process. Documentation inspected included, resident’s care plans, residents’ financial records, risk assessments, staff training records, and some policies and procedures. The inspection also included a tour of the house, and a resident kindly showed me the flat. Assessment as to whether the requirements from the previous inspection had been met also took place during the inspection. Staff and inspection of records confirmed that these had been met by the service. 26 National Minimum Standards, including key National Minimum Standards for adults were inspected during this inspection. The inspector thanks all the people living in the care home, and the staff for their assistance during the inspection process. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Inspection requirements from the previous inspection have been met. The care home has continued to provide a quality service for people using the service. The staff team have developed and improved the environment to make it more homely and attractive for people living in the care home. The garden, sensory room and ‘quiet’ room have continued to be improved, and some redecoration within the home has taken place. Further NVQ (National Vocational Qualification) qualifications in care have been achieved by staff. All except a new member of staff have now achieved an NVQ level 2 or 3 in care qualification. This qualification ensures that staff develop and improve their skills in supporting and caring for the people using the service. Care plan documentation has improved. The key worker system Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 7 for residents has been developed to include co-key workers, and nighttime key workers. Training for staff is provided with the aim of them developing knowledge and understanding of the key worker role. Residents have been supported to follow ‘healthy eating’ menus, and have had the opportunity to attend training days about healthy eating and exercise. A resident has been supported to lose a significant amount of weight. 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. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 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 Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 and 2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for prospective service users to have the information that they need to make an informed choice about where to live. Arrangements are in place to ensure that prospective resident’s needs are assessed to ensure that the service is confident that it can meet that person’s needs. EVIDENCE: The service user guide and the statement of purpose documentation has been reviewed this year. These records are specific to the home, and the resident group that they care for, and set out the objectives and philosophy of the service. The service user guide is in pictorial, and written format. Copies of this document were accessible with each resident’s care plan documentation. The development of a variety of formats to improve the accessibility of the information was discussed with the registered manager. She spoke of plans to improve the format of documentation, which meets the individual capacity of each person using the service, particularly in regard to the complex communication needs of the residents. A DVD and/or CD format were some considerations. This is positive and is recommended particularly in regard to the service user guide. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 10 The care home has an admission policy. There have been no new admissions to the care home for over two years. I had been informed during previous inspections that admissions are not made to the home until a full needs assessment has been undertaken, and that that admissions only take place if the service is confident that staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. Prospective residents receive assessment from Norwood’s admissions coordinator, and the registered manager and/or deputy manager. Residents (generally with support from relatives) participate in this process. A person using the service confirmed during a previous inspection that he was involved in this process, and had visited the care home several times to meet people using the service, prior to moving in. The relevant Local Authority funding authority care manager also assesses the needs of prospective residents. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 11 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): Standard 6,7 and 9 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that all residents have a plan of care, in which they play an active role in planning (as they are able) the care and support that they receive. Residents are supported and encouraged to make decisions and choices, and are supported to take risks as part of an independent lifestyle. EVIDENCE: The care plans have been improved considerably since the previous key inspection. It was evident that care plans were more of a working tool, and focused on the individual strengths, and preferences of residents. Staff record when they had read the care plans. Staff are all fully involved in the care plans and the review process, and spoke of reading the care plans regularly to keep up to date with any changing needs. Three care plans were inspected. These care plans included assessment information with a number of identified needs, including health, personal care , Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 12 behaviour, religious/cultural, and social needs. Each person’s individual assessed needs included comprehensive clear ‘step by step’ staff guidance to meet that need. The care plans recorded evidence that a comprehensive review of the care plan had been carried out every six months with clear goals identified, recorded, and reviewed. It was evident that the resident, relatives/significant others, senior staff, the key worker, and care manager from the relevant funding Local Authority were invited to these reviews. A resident spoke of a care manager recently having attended a review of his care plan. The care plans are also reviewed on a monthly basis and records confirmed that each individual assessed need was reviewed, and that any changes were recorded. The staff team should continue to seek more ways to inform the residents with complex/multiple communication needs of the content of their care plan and of its monthly review. This was discussed with the manager and senior staff member, who agreed to continue to try and develop ways of supporting residents to be more involved with and to understand the content of, their care plans. There is a record maintained of people (such as care manager, health professional, inspector), who has read part or the entire care plan. This is positive. The manager spoke of a resident being offered a copy of his plan of care and that he declined the offer preferring to access it from the office as and when he wished. This should be documented in his care plan. It was evident that staff were aware of the importance of person centred planning and were making considerable progress in putting this into practice. It was evident from inspection that the key principle of the care home is that people using the service are supported and encouraged to take as much control of their lives as possible, and that staff are fully motivated and keen to constantly seek ways in which people using the service (many of whom have multiple/complex needs) can be helped to be fully involved in their care. The content of the care plans indicated that residents were supported and encouraged to make choices, and decisions about their lives. Staff spoke of the various ways in which pictures (and other tools), and their actions had improved the quality of the support provided to a resident. That through this, and staff consistency of care and support, this resident had had fewer episodes of unsocial behaviour, and seemed to be more ‘settled’ and happier. Records confirmed that there was significant accessible staff guidance to ensure that staff supported residents to make choices. Records and a resident confirmed that the times for getting up and going to bed were flexible. A resident spoke of the regular meetings that he had in which he was consulted about his views of the service, and that he felt able to communicate to staff any changes that he thought might improve the quality of his life. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 13 During the inspection I spent a significant amount of time with residents, and staff. Staff were heard to continually offer residents choices. Staff were observed to be particularly sensitive in regards to their interaction with residents. There was considerable ‘one to one’ interaction and staff clearly knew what their role and responsibilities were during their shift, and communicated with each other in a positive manner. Each identified individual resident’s need included a risk assessment, which showed evidence that the service has a ‘can do’ attitude, and that risks are managed positively to help people using the service to lead the life that they want. Care plans clearly recorded individual risks, (and when needed, agreement from a health professional, such as from a GP was obtained) and clear staff guidance to minimise the risk. These risk assessments, which included health and safety risk assessments, recorded evidence of having been regularly reviewed. A resident gave a number of examples of the ways he was supported to be as independent as he could be and that this assessment was kept under regular review. The home has a missing persons procedure. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 14 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): Standards 12,13, 14, 15, 16 and 17 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to make choices about their lifestyle and in the development of their life skills. Social, educational, cultural and recreational activities meet individual expectations. Meals are varied and wholesome, and meet the cultural/religious needs of people living in the care home. EVIDENCE: Each resident has an individual activity plan. This clearly records activities that take place on a daily basis. It was evident from talking with staff, and with a resident, and from observation and inspection of records that activities meet resident’s individual needs, and preferences. It was evident that the care home understands the importance of enabling people using the service to achieve goals, follow their interests, and be integrated into community life. A resident spoke of choosing activities and of enjoying the ones that he participated in. It is clear that the service actively encourages and provides Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 15 imaginative, innovative, and varied opportunities for people using the service to develop and maintain social, emotional, communication and independent living skills where appropriate. A resident spoke of being supported in participating with independent living skills, such as cleaning, cooking and travelling on public transport. During the inspection people using the service were observed with staff support to participate in everyday living skills. The individual activity programmes, include day and evening leisure pursuits, such as, music therapy, art, and crafts, cooking, ‘sing along’, use of the trampoline, and attendance at college. A resident spoke of enjoying visits to the library. Residents spent time decorating the home, and a hut in the garden with lights and other items for the celebration of a religious festival (Succot). Each resident was fully occupied during the inspection; several people using the service were receiving 1-1 staff support. The garden has equipment for residents to participate in football and netball, or use of the trampoline. The home also has a sensory room and quiet room. Residents, with staff support used both of these rooms during the inspection. The home has a passenger vehicle, but at present only one driver, who has her shifts arranged to meet the transport needs of the service. A resident, and staff member spoke of the recent holiday enjoyed by residents at a holiday centre. The residents who live in the flat have a pet cat. A resident spoke positively of the cat and of how they care for the pet. Annual Quality Assurance Assessment (AQAA) information supplied to the Commission for Social Care Inspection from the manager confirmed that residents are supported to obtain travel cards, taxi cards and bus passes. The visitor’s book confirmed that there were many visitors to the care home. It was evident that the home supports residents to develop and actively maintain relationships with family and friends. I was informed by staff that people using the service have varied contact with relatives/significant others. Several residents spend time out in the community with family and friends. At the time of the inspection, one resident was staying with a family member. Records and staff confirmed that there was regular contact by staff with relatives/significant others in regard to informing them (with the resident’s agreement) of the progress of their relative/friend living in the home. AQAA information recorded that the home was continuing to try and recruit ‘befrienders’ or independent advocates particularly for those residents who have limited family contact. Staff spoke of some residents celebrating religious festivals with family and friends. A staff member described that arrangements made and support given for a resident to attend a relative’s recent funeral. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 16 It was evident from talking with staff, a resident, and from observation and inspection of records that people using the service have their rights fully respected and their responsibilities recognised in their daily lives. I was informed by staff that following assessment, and agreement with residents, some residents have their own front door key. Staff call residents by their preferred name. Religious and cultural needs (including a resident who is not Jewish) are being fully met by the care home. A resident kindly showed me a framed article from a well known magazine in which they had been interviewed about their life. The home has a menu. This is displayed in the kitchen. Records confirmed that there was guidance to ensure that staff were aware of their role in supporting residents to plan meals. This guidance was linked to the religious festivals celebrated by the home. The meals for the day are also displayed in large colour photographs on a display board in the dining area. Choice is recorded on this display board. The menu indicated that residents each week had a preferred meal incorporated in the menu. A staff member spoke of the plans to develop specific pictures for a resident who is following a particular ‘healthy eating’ menu. Staff spoke of how they gained an understanding of the food preferences of residents, particularly of those who do not communicate their needs verbally. It was evident during the inspection that residents each chose different breakfasts according to their preferences, and that staff had understanding of each resident’s dietary needs and choices. One resident has been supported to lose a significant amount of weight by following a healthy eating menu, and from attendance of a community organisation for supporting people to lose weight. All food meets Kosher needs and requirements. Food is bought from Kosher food producers. Some items are bought locally as, and when needed. A resident spoke of shopping for food products locally. Residents were observed to participate (with staff support) in the preparation of lunch during the inspection. The home has numerous colourful recipe books, which are accessible to residents. During the inspection residents were observed to be supported/assisted with their meal as and when they needed. Staff interacted with residents positively (by describing the meal, encouraging and praising) when they helped them with their meal. Regular drinks and snacks were offered to people using the service during the inspection. Staff, records and a resident confirmed that residents have the opportunity to celebrate Shabbat every week. A special meal is prepared, and a volunteer supports residents with the prayers, blessing and lighting of the occasion. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 17 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): Standard 18,19 and 20 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that resident’s personal support needs are met in the way they prefer. Physical and emotional healthcare needs are met, and the principles of respect, dignity and privacy are put into practice. Medication is generally stored and administered safely. EVIDENCE: It was evident from talking with staff, a resident, observation and inspection of records that staff have knowledge, and understanding that meeting the healthcare and personal care needs of people using the service are key issues in their plan of care and support. Preferred personal care needs of people using the service were recorded in their individual preferred morning and night routines. Comprehensive staff guidance to meet those needs was documented. A resident spoke of the support that he received from staff with his personal care needs. It was evident from the records inspected that staff were very knowledgeable of the individual and varied needs of each resident. Staff spoke of care and support being provided to residents in a flexible and consistent manner, which meets Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 18 their changing needs. It was clear that staff respected the privacy of residents during the inspection. Care plans recorded evidence that the individual health needs of residents are met. There is recorded staff guidance to meet the particular health needs (such as epilepsy needs) of residents. Staff who spoke to me were aware of this guidance and of where to access these records. Treatment and care for residents from the GP, dentist, optician, and chiropodist were recorded. Attendance at specialist clinics and hospital clinics were also documented. It was evident that advice was sought as and when required from health care professionals, and that referrals were made in accordance to resident’s needs, and their changing needs. The home has a medication policy. Staff record when they have read the procedure. The medication storage, and administration systems were inspected. Medication is stored securely. I was informed by a senior staff member, and by records that staff receive medication training from a pharmacist, and also receive a documented ‘in house’ medication assessment of staff competency in regard to the safe administration of medication. A senior staff member spoke of the ongoing monitoring processes, (such as ‘spot checks’) which ensure that medication is administered by staff to residents safely. Two staff participate in the administration of medication. A list of staff signatures is recorded. Medication administration records were up to date, and had no gaps in recording. Staff guidance in regard to meeting the medication needs of residents who have particular health needs, is clearly documented. A pharmacist regularly inspects the medication storage and administration systems in the care home. The care home has a sustained record of compliance with safe storage and medication administration procedures. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 19 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): Standard 22 and 23 People who use this service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring that complaints are taken seriously and handled appropriately. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm. EVIDENCE: The home has a complaints procedure. This is in pictorial, and written format and is documented in the service user guide. A resident spoke of being confident that any concern/complaint that he/she may have would be listened too and be closely and acted upon. He/she spoke of talking to the manager or key worker if he/she had a concern/complaint. Staff who spoke with me had knowledge and understanding of how to respond to a complaint/concern. There had been no recorded complaints since 2004. The home has a protection of vulnerable adults policy, which records when an incident needs to be referred to the Local Authority. Since the previous inspection the home has obtained the Safeguarding Adults procedures of all the Local Authority funding authorities linked to the care home. Staff confirmed that they were fully trained in regard to Safeguarding Adults. Staff who spoke with me, had knowledge and understanding of the procedures in regard to reporting and recording, following an allegation or suspicion of abuse. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 20 A safeguarding issue that took place in 2006 was managed appropriately and has been resolved. Incidents/ accidents are recorded appropriately. Care plans inspected included recorded strategies for supporting and responding to challenges to the service from residents. Staff receive training in the management of ‘challenging’ behaviour, and there is clear recorded staff guidance to meet these individual needs of residents. Care plans include assessment of resident’s financial needs. Resident’s monies are appropriately managed. A sample of three residents monies and records were inspected. There are clear transparent systems in place to ensure that any resident’s monies managed by the care home are managed as required. To further improve the systems of safeguarding resident’s finances, checks/audits of resident’s monies could be included in the monthly visit by the provider. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 21 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): Standards 24, 25 and 30 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is accessible, safe, homely, clean and comfortable. The premises are suitable for the care home’s stated purpose. Residents bedrooms are individually personalised, meet their individual needs. EVIDENCE: The home is located close to a variety of local amenities, including shops, banks, restaurants, pubs and a park. Public transport facilities include train, and bus services. The home is purpose built and consists of the main house, and a flat for two people adjoining it. The inspection included a tour of the premises (including the flat). There is a large welcome sign displayed on the sitting room door. The front of the home, forecourt area was ‘weedy’ in some areas and attention to this could improve the attractiveness of the front entrance to the care home. There is an agreeable seating area with a table and chairs located at the front of the house. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 22 The care home is well maintained. The home is fully accessible to people using the service, and has a passenger lift. The environment of the care home continues to be improved and developed. There are numerous homely features. These include displayed pictures, up to date photographs of residents from a variety of holidays, day trips and other activities. The décor is colourful and attractive. Furnishings have been specifically chosen to meet the individual needs of residents. It is evident that the staff team have continued to work hard to improve the attractiveness and homeliness of the home. The environment meets the diverse needs of people using the service, and is non-institutional. Pictures were displayed on doors to describe the rooms, and pictures were also displayed on some equipment such as on the fridge, freezer and microwave. Staff spoke of the ways they aimed to continue to develop the environment of the home. A resident kindly showed me the flat were two residents live. This is homely, and generally well maintained. The carpet in the sitting room should be cleaned. A resident spoke of there being plans to change this flooring. There are some areas of paintwork in the care home that could be repainted, such as in some bathroom areas. The home includes several areas including the upstairs night staff office, which can be used as meeting rooms for residents, staff and others. Appropriate equipment used for meeting resident’s needs is accessible. The garden has been significantly enhanced since the previous inspection. It has attractive flowerbeds, and garden furniture (including outdoor beanbags), and other items to enable residents to participate in a variety of leisure pursuits. Staff spoke of how residents regularly accessed the garden facility during the good weather in the summer months. This included an ‘open day’ held at the home, and numerous visitors attended the celebration. Several bedrooms were inspected. These were all individually personalised and were clean, light and airy. Two residents who kindly showed me their rooms indicated that they liked their bedrooms. Each room is bright and colourful, with lots of possessions, and items of resident’s individual choice. Residents were observed to access their bedrooms freely. Pictures and names of each resident were displayed on their bedroom door. The home employs a domestic staff member. She kindly spoke to me of her job role. The house was very clean and odour free. Laundry facilities include industrial washing and drying machines are located away from food storage and food preparation areas. A resident spoke of participating in the care of the laundering of his clothes. There are clear recorded guidelines for the use of the laundry. There are accessible disposable gloves and aprons. Staff were observed to wear these when appropriate. Alcohol hand cleanser, soap and hand towels were available in the bathrooms/toilets inspected. AQAA information recorded that the Organisation is addressing infection control training for staff. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 23 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): Standards 32,34, 35 and 36 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff receive training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities. Arrangements are in place to ensure that residents are supported and protected by the care home’s recruitment policy and procedures. EVIDENCE: The staff rota was available for inspection. This records the up to date qualifications of the staff on duty such as those who have 1st aid qualifications, epilepsy training and medication training. The home was judged to be well staffed. I was informed by staff, and by records that there were generally at least four care staff on duty in the day (three to four in the afternoon), and two staff on duty at night. Staff receive a staff verbal ‘handover’ at the beginning of each shift. I attended the afternoon staff handover session. It was evident from this meeting that staff receive a comprehensive progress report in regards to each resident. Residents were observed to receive significant 1-1 care and support from staff during the inspection. The names (and the qualifications) and pictures of the staff on duty were displayed in the communal sitting room area. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 24 I was informed that there is a low staff turnover rate. The home shares (with other Norwood homes) a pool of ‘cluster’ care staff who as part of their induction spend time working in the care home getting to know the residents. Staff spoke of this being significant in ensuring that residents are supported by staff that know them well. This is positive. A member of staff was undergoing this induction process, during the inspection. Residents have day and also night key workers. Staff spoke of their key working role and responsibilities, and demonstrated full understanding of resident’s particular, and varied needs. Recorded guidance in regard to key working duties and other individual staff responsibilities, was accessible to staff. A resident spoke positively of their key worker. AQAA information documented that staff had received a three hour coaching session about the key working role. A recorded ‘shift planner’ in which the roles of staff for that shift are clearly documented. Staff were observed to interact positively with other staff and with the people using the service. A staff member spoke positively of the staff team. I was informed that a second senior staff member (A grade) had been appointed. This is positive. The management of the home facilitates staff members to undertake NVQs (National Vocational Qualifications) level 2 and/or 3 in care. All except one new staff member have completed or are in the process of completing an NVQ care course. A staff member spoke of having completed an NVQ level 2 care course, and of plans to completed NVQ level 3 in care. A senior staff member has recently achieved an NVQ level 4 qualification in management and care. Staff receive a twelve week, induction programme (linked to Skills for Care Induction standards), and also receive an in house induction. A staff member confirmed that it was a comprehensive programme, and included a period of observation/shadowing of more senior staff. The home has a staff training plan, and individual staff training plans. Records, and staff confirmed that staff receive relevant and appropriate training that ensures that they have the skills to be competent in regard to meeting residents’ varied and complex needs, and so improve the outcomes for people using the service. Staff training includes diversity and equality training, understanding cultural and religious needs, health and safety training, and moving and handling training, and first aid training, and food and hygiene training. Other training specialist training for meeting the particular needs of the people using the service. External providers deliver some of the staff training; other training is provided from those with appropriate skills within the organisation. Staff spoke of receiving ‘lots’ of training. Training in regards to managing ‘challenging’ behaviour had recently taken place, and I was informed of planned staff training, which includes ‘diabetes awareness’ training. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 25 It was evident from speaking to a resident and from observation that the residents know the staff team well. Staff demonstrated an understanding of the varied communication needs of residents during the inspection. The care home has a recruitment and selection procedure. The manager and information from previous inspections confirmed that the procedure for recruitment of staff is comprehensive and consistent. Staff interviews include a written test. Staff personnel files were available for inspection. Information was not easily accessible. The manager spoke of her plans to review the staff files and to put them in good order. Recorded evidence that Criminal Record Bureau checks having been carried out was not accessible in the staff files inspected, and only one staff reference was accessible in a staff file inspected. Following the inspection the manager supplied the Commission for Social Care Inspection with all requested staff personnel information. Records confirmed that staff are supplied with a job description, and terms of conditions, staff handbook, and staff code of conduct. The manager confirmed that residents meet staff during the staff selection process, and she spoke of her plans (with involvement from Norwood) to develop the ways that people using the service could be more involved in staff recruitment. She reported speaking about this issue with senior Norwood staff. This is positive. Staff appraisals are carried out. AQAA information confirmed that all staff have received a formal appraisal in 2007. A staff appraisal took place during the inspection. Staff spoke of receiving regular staff supervision. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 26 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): Standards 37,39 and 42 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager is qualified, competent and experienced to run the care home. Arrangements are in place to ensure that effective quality assurance and quality monitoring systems are in place to monitor and improve the quality of the service provision by the care home, but required unannounced visits to the home need to take place. Arrangements are in place to ensure that so far as reasonably practicable the health; safety and welfare of residents and staff are promoted and protected. EVIDENCE: The registered manager has several years experience of working with adults who have a learning disability, and is highly competent to run the care home, Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 27 and meet its stated aims and objectives. She has managed the care home for several years, and has completed an NVQ assessor’s course (D32/33), Registered Managers Award, and a NVQ level 4 in care course. The manager confirmed that she updates her knowledge and skills. The manager generally works weekdays but does work a variety of shifts during the day and evening. The registered manager remains proactive in regard to improving the service, including ensuring that staff receive appropriate training, and she continues to work hard to meet the National Minimum Standards for adults, and inspection requirements. It is evident that the registered manager has a clear vision of the home based on the organisations values and policies, and has a good understanding in regard to using the significant staff skills amongst the staff team, by appropriate delegation of staff duties, and responsibilities. Nominated staff are responsible for jobs such as gardening, activities, food planning and for ensuring that the cultural needs of residents are met. Staff and a resident confirmed that the manager is approachable, and supportive. From speaking with the manager and staff, it was evident that she with the other senior staff members communicates a clear sense of direction and has a sound understanding and application of ‘best practice’. Records confirmed that the care home has effective quality assurance and quality monitoring systems in place, which include reviewing care plans, health and safety checks, staff training, and environmental maintenance issues. The manager completes an annual development/business plan. This was last reviewed in August 2007. The manager confirmed that satisfaction surveys had been supplied to staff, and that the home supplies (on a regular basis) questionnaires to residents (depending on assessed ability) and relatives/significant others, in regard to their views of the service. She spoke of feedback being positive. Records and staff confirmed that regular contact is maintained with relatives and significant others, and that their on going views of the service are encouraged. Records, including policies and procedures are kept up to date and are regularly reviewed. The home has a comprehensive range of policies and procedures. The manager spoke of her plans to ensure that the format of a range of policies and procedures (those of particular relevance and interest to residents) would be developed and improved to ensure that the information is accessible as possible to residents. This is positive. I was supplied with a copy of Norwood’s newsletter, which was recently launched and copies of which are supplied to the care homes and to others. The manager spoke of her plans to develop a newsletter specifically for the home. Records and staff confirmed that staff meetings take place regularly. Records confirmed that night staff also attend staff meetings. The progress of people using the service are among the items discussed in staff meetings. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 28 There were no records that monthly unannounced visits to the home had been carried out recently by a representative of the owner of the home. The last recorded visit was 16/2/06. These quality monitoring visits need to be carried out, to ensure that the quality of the service provided to residents is being closely monitored by representative of the provider who is not employed in the care home. It was noted that liquid eraser was being used to make adjustments to the staff rota. Liquid eraser should not be used on documentation/records used in the home. This practice was ceased during the inspection. The care home has appropriate and sound procedures and systems in place to ensure that the home is safe. The organisation ensures that health and safety systems meet relevant legislation. Staff receive health and safety training. Recorded health and safety guidance (such as washing hands) for staff and residents is displayed in the care home. A list of staff that have achieved an appropriate food and hygiene qualification is displayed in the kitchen. Staff receive ‘in house’ as well as external moving and handling training in regard to the use of a resident’s hoist lifting aid. This previous requirement was judged to have been met. A resident and records confirmed that he had agreed a personal safety contract. Maintenance checks are carried out frequently. An issue in regards to a possible faulty door opening device was responded to promptly following it being detected. Certificates of worthiness that were inspected including annual safety checks of the electric and gas systems were up to date. Fire safety checks are carried out as required. Fire drills are documented. I was informed that these are all unannounced, and include night time fire drills. A senior staff member reported that fire drills were being carried out more frequently. Water temperature checks are monitored. Fridge freezer checks are made twice a day. Hot water randomly tested by me during the inspection was judged to be of a safe temperature. The manager reported that a satisfactory recent inspection from an Environmental Health officer recently took place. Accidents and incidents are recorded appropriately. The certificate of employers liability insurance was up to date and displayed. Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 29 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 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 4 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 4 X 4 X 3 X X 3 X Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 30 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 YA39 Regulation 26 Requirement The registered person needs to ensure that quality monitoring visits to the care home need to be carried out, to ensure that the quality of the service provided to residents is being closely monitored. Timescale for action 01/01/08 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 YA1 Good Practice Recommendations The registered person should develop further ways of improving the format of the service user guide for those people using the service who cannot read and nor understand pictures. To further improve the systems of safeguarding resident’s finances, checks/audits of resident’s monies could be included in the monthly visit by the provider. • Weeding garden areas and the forecourt could improve the attractiveness of the front of the home. • The carpet in the sitting room of the flat should be clean or replaced. 2 3 YA18 YA24 Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Norwood 60 Carlton Avenue DS0000017520.V344031.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!