Inspection on 17/02/09 for 17 Park Avenue

This inspection was carried out on 17th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

17 Park Avenue 08/04/10

17 Park Avenue 12/01/10

17 Park Avenue 23/11/07

17 Park Avenue 26/01/07

17 Park Avenue 25/05/06

17 Park Avenue 10/11/05

17 Park Avenue 16/05/05

17 Park Avenue 24/01/05

17 Park Avenue 23/11/04

17 Park Avenue 17/03/04

17 Park Avenue 09/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Park Avenue, 17 Park Avenue, 17 Hockley Birmingham West Midlands B18 5ND     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Brenda ONeill     Date: 1 8 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Park Avenue, 17 Park Avenue, 17 Hockley Birmingham West Midlands B18 5ND 01215233712 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : faisalazam@london.com Park Avenue Limited care home 22 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 22 Residents must be aged under 65 years with a mental disorder Staff at the home do not administer insulin, and healthcare professionals are contacted to provide this support where service users cannot self administer. That the home can care for one named service user in need of care due to physical disability and mental health needs (1PD/MD). The details regarding how his specific care and social needs will be met must be included in the service users plan. Three named service users over 65 years with a mental disorder can be accommodated whilst their needs can be met at the home. Date of last inspection Brief description of the care home 17 Park Avenue is a care home for up to 22 adults that are experiencing mental health problems. The home is situated close to local amenities such as shops, places of worship and public transport links. There are six shared bedrooms and ten single bedrooms, none of which have en suite facilities. There are two lounges on the ground floor. The home has a passenger lift and there is ramped access to the front of the Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home building. Some adaptations have been made to bathrooms to enable people with a physical disability to shower and bathe. There is a well established team of staff, some of whom have worked in the home for many years. Information is shared with people who live at the home during house meetings and there are leaflets describing how to make complaints available in the entrance hall. Many of the people living in the home do not speak English as a first language. The staff team have the skills collectively to communicate with people in their first languages. The range of fees charged charged for living at the home was not detailed in the service user guide. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at the home was carried out on November 23rd 2007. This inspection was carried out over one and a half days in February 2008. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets Care Homes for Adults (18-65 years) Page 6 of 34 the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. We sent eight Have your Say surveys to the people who use the service last year however none of these were returned. What the care home does well: What has improved since the last inspection? What they could do better: The information in care plans needed to be consistent and describe how the needs of the people living in the home were to be met. This would ensure the people living in the home received consistent, person centred care. Risk assessment needed to be more robust and clearly detail how staff were to minimise any identified risks. This would ensure the people living in the home were not placed at risk of unreasonable harm. To ensure that the confidentiality of the people living in the home was maintained financial information needed to be stored securely. There needed to be evidence that the people living in the home had the opportunity to take part in social and leisure activities that met their needs and preferences. Management plans needed to be in place for any ongoing health care needs. This would ensure peoples health care needs were monitored and that any deterioration was addressed appropriately. Care Homes for Adults (18-65 years) Page 8 of 34 Regulation 37 notifications needed to be sent to the Commission for any incidents that affected the well being of the people living in the home. This would ensure incidents are being managed in the best interests of the people living in the home. The home should have a quality assurance system in place that details how the service is to be improved for the people there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information available for people to determine if the home could meet their needs needed to be updated to ensure it was current and in a consistent format in all languages. There were procedures in place to ensure the needs of people being admitted to the home were fully assessed to ensure they could be met. Evidence: There was a service user guide for the home which was dated November 2008. The document needed to be reviewed as although it gave considerable information about the home some of it was not up to date. For example the address for the Commission was incorrect and the person named as the manager had not been employed in that post for a considerable amount of time. The guide did not include the range of fees charged at the home. It was also noted that there were several pictures in the guide to make it easier for people to understand. The pictures did not reflect the various cultures of the people that live at the home. We were told that the guide was available in a variety of languages. These were seen but they were hand written and did not include any pictures. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: There had been no new people admitted to the home for some time therefore the pre admission process could not be fully assessed. The home did have an admissions procedure which indicated any people admitted to the home would be fully involved in the process. This was also explained in the service user guide. We were shown the assessment document that would be used by the manager of the home for gathering information prior to admission and this would be appropriate. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments do not always fully explain the levels of support that people require to make sure that their needs are met. This could lead to inconsistent care and or needs not being met safely. People that live in the home received support to make choices and decisions about their lifestyles. Evidence: The care for three of the people living in the home was tracked during this inspection. This involved us sampling the care plans and risk assessments that were in place for the individuals. There were care plans in place and they had been recently reviewed as required at the last inspection. Areas covered in the plans included personal care, mobility, communication, diet and going out. The detail in the care plans varied. In most instances the information was very brief and did not include the detail that would be required by staff who did not know the individuals to enable them to meet peoples Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: needs. For example, nails (weekly) but did not detail what staff had to do to the nails, wishes to keep his hair and beard a little longer than usual due to his religion there was no explanation with this to say what longer than usual was. The care plans gave only minimal details about the cultural needs of the people living in the home. There were some comments about the preferred languages of people, the preferred clothing was mentioned for one person and the preferred places of worship were mentioned for some people. The staff group were from different cultural backgrounds and could not be expected to know the cultural needs of all the people living in the home. These needed to be clearly detailed in the care plans to ensure peoples needs were met. One of the people living in the home had very little verbal communication. There was no specific care plan in place for this. It was briefly mentioned in social skills as speech is affected and finds it hard to have a conversation. Some staff were able to tell us how they communicated with the individual by speaking slowly and using gestures and that she would indicate what she wanted. Staff needed specific written guidance with this so that the individual received consistent support. Another person had quite a detailed plan in place for enabling staff to communicate with him. This detailed the preferred language, that staff were to use basic words and how the individual would sometimes communicate by pointing. There was a lot of conflicting information in care plans and risk assessments. For example one care plan stated the person needed one person to help them in the shower however the risk assessments for moving and handling stated two staff were needed. When staff were asked one said they did it on their own another said there was always two of them. Another care plan for diet stated the individual liked it when staff fed her but further on stated refuses staff assistance. The information in the care plans and risk assessments needed to be consistent so that staff knew exactly how they were to support people safely. The risk assessments in place had also been reviewed since the last inspection. The majority of the risk management plans seen needed to be further developed to ensure staff had clear guidance on how to minimise risks. One person had risk management plans in place for verbal and physical aggression. The plan for verbal aggression was quite detailed and described how staff were to try and prevent the behaviour escalating by doing such things as joining in with activities, going for a walk or talking to staff. The plan for physical aggression needed much more detail as it stated such things as use all diversion techniques but did not say what these were. It also went on to refer staff to some specific strategies but when we Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: asked the acting manager where these were they were not available. Staff were asked how they managed the presenting behaviour of the individual and we received three different responses. One said the individual was not aggressive, one said not to make eye contact and another said make eye contact. Risk management plans needed to be robust to ensure staff knew exactly how to manage any presenting behaviours safely. Again some of the information in the risk assessments was conflicting or did not cross reference to the care plans. One stated that the individual could panic when the fire alarm went off and that the individual needed to be in a place of safety and not moved by staff. In another part of the same plan it stated to be put at the assembly point. This information was very confusing for staff and could lead to inconsistent practice. The care plans gave some examples of where the people living in the home were able to make decisions, for example, wether they prefer bath or shower and their preferred activities. There was a good range of food on offer at the home that people could choose from. Where they were able people were seen to come and go from the home during the day. The records for the meetings held with the people living in the home were seen. These showed that people were listened to and staff acted on their suggestions for example, people had requested a party for Eid and this had taken place. Some colleges had been approached to see what they could offer the people living in the home. Staff were able to tell us how the activities had increased and more people were going out as this was what they wanted. It was noted that the care files included details of the financial arrangements in place for the people living in the home. This included detail of their income. It is strongly recommended that this information is removed as it is not needed by the staff supporting the individuals and should be confidential. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Efforts were being made to increase the range of activities offered so that the people living in the home lead meaningful lives. People were offered a range of food that met their cultural needs and preferences. Evidence: The care plans in place at the home did identify the preferred activities of the people living there. The records in the home did show that some of the preferred activities were taking place but staff were not recording everything. For example, one of the people living in the home went to the Mosque every Friday this was not being recorded on a regular basis. Staff needed to record the activities people were taking part in, particularly where individuals were unable to comment, to show people were leading fulfilling lives. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: The care plan for one person indicated he would like to travel and visit family in Pakistan. We were told this was being arranged and he was only waiting for his passport. The care plan evaluations did not give any details of this happening. One person told us she went out regularly. She had been out for a medical appointment and to the temple and that she went in a taxi. Another person had not been out to Star city with other people because he said he was not well. Staff were able to tell us about the places people went during the day such as shopping locally, to the park, to the cinema and to the temple. The home had their own transport for people to use and had recently purchased a wheelchair accessible vehicle. The acting manager stated that they were looking at what further activities people could be involved in and local colleges had been approached to explore what courses were available. While at home staff were seen to facilitate some activities such as skittles which people appeared to enjoy. Some people were seen to have one to one time with staff and had their toe nails painted and were taking part in simple exercises. People also came into the home to facilitate some activities, for example, progressive mobility and aromatherapy. There was some evidence in daily records of people being in contact with their families either by them visiting the home or of individuals going out to see them. However the care plan for one person stated her key worker would contact her family to ask when they were to visit. There was no recorded evidence to show this had been done. The person concerned was unable to communicate verbally and not able to tell us if her family had visited. Menus and records of food consumed by individuals were sampled to establish that a balanced and varied diet is provided that meets peoples needs and preferences. A range of food had been offered, including vegetarian and Halal meals, which is reflective of peoples cultural needs. We sampled the range of food on the day of the inspection and found this to be very good. People appeared very satisfied with the food. One said the food was good another person told us she had had boiled vegetables as she did not feel too well. There were plans for the former smoking room in the home to be converted into a kitchen for the use of the people living in the home. This will enable those that are able to make their own drinks and snacks and to receive some support to cook for themselves. Care Homes for Adults (18-65 years) Page 17 of 34 Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place to make sure that people stay healthy and well are not robust and could lead to peoples needs not being met. The systems in place for managing medication were good and ensured people received their medication as prescribed. Evidence: There was some information in care plans about the personal care needs of the people living in the home however as previously stated this could have been further developed. The staff we spoke with were aware of the needs of the people living in the home in relation to their personal care. They were able to tell us how they supported people and what people were able to do for themselves. Staff were aware of the issues in relation to gender sensitive care and described how they had been asked to go into work to bathe someone as the appropriate gender staff were not on duty. The health care records sampled varied with regard to detail. Some described clearly how to support people to maintain good health and listed regular contact with health Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: care professionals and the outcome of the contact. One of the people living in the home had quite a detailed management plan in place for diabetes which described what staff would see if the condition deteriorated and what they should do about this. Staff spoken with told us how they ensured people with diabetes remained in a stable condition. It was evident from the medication one person was receiving they had an ongoing health condition. There was no information on the individuals file in relation to this or what staff would have to do should the person have a seizure. It was important for this information to be available for the staff so that it could be assured they would know what to do in the event of the person having a seizure. The information on the care files in relation to peoples mental health was minimal. There was no guidance for staff to tell them how they would recognise if peoples mental health was relapsing or what they should do about this. As the home is registered for people experiencing mental health problems this information was vital to ensure their well being. The records sampled generally showed that people had access to a variety of health care professionals such as G.Ps, chiropodists, opticians, dentists, dieticians and continence advisors. Records showed that people attended hospital appointments and local clinics as necessary. One of the people living in the home told us she had been for her injection another said staff arrange hospital appointments, I have an injection the nurse does it. On occasions the outcomes of medical appointments were not clearly recorded in peoples records which could lead to staff not having the necessary information. For example, one person had been having some health issues which we were told had been addressed with the G.P. Staff had continued to refer to the issue in daily records as if it had not been addressed. Had the records been explicit and the information passed on to staff this would not have happened. The pharmacist inspector was asked to visit the home to audit the medication system. The pharmacist inspection lasted one hour. The medication for three people was looked at together with their Medicine Administration Record (MAR) chart and care plans. The manager was present during the inspection and all feedback was given to him and the new responsible individual. The medicines were kept in a locked medicine trolley secured to a wall when not in Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: use. A dedicated medication refrigerator was available to store medicines requiring refrigeration. The home sees all the prescriptions prior to dispensing and then makes a copy of these to check the medicines and MAR charts into the home. Most MAR charts had been written by the pharmacist. Additional medicines dispensed had been hand written on the charts. These were well written and accurate. A daily check of the balances of the medicines dispensed in traditional boxes and bottles is done to ensure that all the medicines are administered as prescribed. Whilst this system is time consuming, audits undertaken during the inspection indicated that the medicines had been administered as prescribed and records reflected practice. This was commended. Protocols written for medicines prescribed to be administered on a when required basis were well written and would support the care assistants to administer the medication only when necessary. The care plans lacked information about the clinical conditions of the people living in the home. These would not enable the care assistants to fully support the clinical needs of the people they look after. The responsible individual and the manager were both keen to improve these as soon as possible. Care Homes for Adults (18-65 years) Page 21 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate procedures in place to listen to peoples concerns and complaints and safeguard them from harm. Evidence: There was a complaints procedure available for the home and this had been translated into various languages to reflect the needs of the people living in the home. The procedure did need the address for the Commission changed to the current address. We have not received any complaints about the home since the last inspection. The complaints log at the home detailed one complaint that had been received from a relative this had been managed appropriately. Staff spoken with knew the importance of listening to people and were able to tell us how they knew when some of the people living in the home were unhappy. Throughout the inspection it was evident people were comfortable in the presence of the staff which would give them the confidence to raise any issues. Staff spoken to during this visit confirmed that they had received training in adult protection. Observation of the homes training matrix showed that 90 percent of the staff team had received this training and challenging behaviour training to assist them to meet peoples needs more effectively. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: Some of the people living in the home managed their own money others had support from the staff at the home. The systems in place for ensuring peoples money was safe were sampled. Some of the people living in the home had their personal allowance paid into the business account for the home. The acting manager was exploring this and looking at ways of how this could be changed so that people could have their money paid into their own bank accounts. The personal allowances were drawn out of the account every week. Some people had the full amount back and signed to say they had received this. Others had money kept for them on an ongoing basis. Any expenditure made on behalf of people was documented and receipts were kept. There were some occasions where the receipts needed to be more detailed and state exactly what was purchased particularly when this involved larger amounts of money so that it was clear what had been purchased. Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided the people living there with a comfortable environment in which to live. Evidence: 17 Park Avenue is situated off the Soho Road area of Hockley in Birmingham. The home is well placed for access to local amenities such as places of worship, public transport routes, shops, cafes and restaurants. This is important for the people who live there as they enjoy accessing community based activities. A tour of the home was undertaken at this visit and two bedrooms were seen. The home was comfortable and there was some decoration ongoing throughout the home. We were told that there are plans for new flooring in the lounge and on the corridors of the upper floors of the home. The AQAA that had been returned to us stated the home had a rehabilitation kitchen. This had not been installed at the time of this visit but we were told it was on order and was to be installed in the former smoking room in the home. This will enable people to be more independent. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: There were some relatively minor issues raised in relation to the environment. One of the showers was not working (this was being addressed on the second day of the inspection), the drain covers in two of the showers were missing, some of the shower/bath seats needed to be thoroughly cleaned to ensure good infection control was maintained and some of the internal extractor fans in the toilets and bathrooms were not working. There were a range of toilets and assisted bathing facilities located throughout the home for ease of access for those living there with a physical disability. Two bedrooms were seen one double and one single. These were generally well decorated and furnished and met with the needs of the occupants. It was noted that the double room had no screening available. We were told the occupants of the room did not want this however there was no evidence seen that this had been discussed with the people occupying the room. One of the people occupying the room was unable to say if this was what she wanted. It was also noted that there were large padlocks on the wardrobes in this room. We were given two different reasons for this and were not able to confirm with the occupants what the reasoning was. We were told that one of the people did have the key to her padlock. If locks on wardrobes are necessary they should be discreet and the reasoning for them should be documented in care plans. This will ensure people are not restricted access to their clothing unnecessarily. The people living in the home appeared very comfortable and were satisfied with the environment. Care Homes for Adults (18-65 years) Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a well trained and competent team of established staff who have a good understanding of their individual needs. The home operates a robust system of recruiting staff. Evidence: Staff turnover at the home was very low which was very good for the continuity of care of the people living there. Clearly staff had good relationships with the people living in the home. Interactions seen were very positive. Staff were seen to spend a considerable amount of time with the people living in the home talking to them on a one to one basis, facilitating activities and providing support with personal care. There was a lot of friendly banter between the staff and the people living in the home. We spoke with several staff and they were able to tell us about the needs of the people living in the home and how they supported them. The acting manager told us that staffing levels were appropriate for the numbers and needs of the people living in the home at the time. There were only thirteen people Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: living in the home and we were told staffing levels were three staff throughout the day and two at night. The rotas confirmed this and was seen in practice during the inspection. There were also cooks and cleaners employed at the home. Staff spoken with told us about the training they had undertaken and were satisfied that they had received enough training to enable them to care for people safely. The training matrix for the home also indicated staff had received mandatory health and safety training. Some specific training such as managing challenging behaviour, diabetes care and British Sign Language had been provided, which is reflective of the needs of the people who live in the home. The training matrix indicated that 4 of the 19 staff at the home had NVQ level 2 but another 6 were working towards this and 5 staff were also working towards level 3. Recruitment records sampled showed that appropriate checks had been made to make sure that staff were suitably experienced and qualified to work with vulnerable adults. Criminal Records Bureau checks had been made and written references received before the employee began work so that people were protected from the risk of having unsuitable staff work in the home with them. The staff files sampled indicated that the frequency of individual supervision sessions varied and would not reach the required target of six per year. This was needed to review the roles and responsibilities of the staff and identify any individual training needs to assist them to meet the needs of people who live in the home more effectively. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needed a stable management team to ensure it was managed in the best interests of the people living there on an ongoing basis. Evidence: The home has not had a registered manager for some time and there have been several changes in the management of the home since the last key inspection. We were notified that a new manager had been appointed in September 2008. This person was no longer working at the home and another acting manager was in post. The acting manager at the time of this inspection had worked at the home for some time in a senior position but told us he had only been the acting manager for two weeks. He demonstrated throughout that he knew the needs of the people living in the home. He was receptive to the comments made throughout the inspection. He was advised that the care plans and risk assessments for the people living in the home needed to be further developed to ensure people were cared for safely and in the way they wanted. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: We also spoke to the person who is to be the new responsible individual for the home and a new operations manager. We discussed our findings with them and they were aware of the shortfalls in the home and committed to improving the service for the people living there. They spoke of the plans for the home including enhancing activities and encouraging people to be more independent wherever possible. Installing a kitchen for the use of the people living in the home was one of the priorities. Staff spoken with were very positive about the new acting manager saying he was very much a hands on manager and was very approachable. The people living in the home were comfortable in his presence. There did not appear to be a formal quality monitoring stem in place in the home and the acting manager was not aware of a development plan being in place. There were some ways of monitoring the service, for example, meetings with the people living in the home to get their views, staff meetings and occasional satisfaction surveys. It was over a year since the last satisfaction surveys had been issued to the people living in the home, their relatives, visiting professionals and so on. A representative of the registered provider visits Park Avenue on a regular basis to comment on the standard of care provided, which contributes to the management of the home. The home needed to have some formal systems in place for monitoring the quality of the service. Information gained from monitoring systems should be compiled into a development plan for the home that shows how the service is to be improved for the people living in the home. The information requested by us in the AQAA in relation to the servicing of the equipment in the home had not been included. The information was available in the home and showed that all the servicing was up to date. There was also evidence that the water system had been checked for the prevention of legionella and that the home had the appropriate insurance cover. Some of the accident forms and daily records for the people living in the home indicated there had been some incidents in the home that we should have been notified about. The acting manager was advised that he should ensure we are notified of all incidents in the home that affect the well being of the people living there so that we can be assured that are being appropriately managed. Care Homes for Adults (18-65 years) Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 12 The information in care plans must be consistent and describe how the needs of the people living in the home are to be met. This will ensure the people living in the home received consistent, person centred care. 30/04/2009 2 9 12 Risk assessment must be 30/04/2009 robust and clearly detail how staff are to minimise any risks. This will ensure the people living in the home are not placed at risk of unreasonable harm. 3 19 12 Management plans must be in place for any ongoing health care needs. This will ensure peoples health care are needs are monitored and any deterioration addressed appropriately. 30/04/2009 Care Homes for Adults (18-65 years) Page 31 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service user guide should be updated to include all the current and necessary information that people would need to help them decide if the home could meet their needs. To ensure that the confidentiality of the people living in the home is maintained financial information should be stored securely. There should be evidence that the people living in the home have the opportunity to take part in social and leisure activities that meet their needs and preferences. Staff should enable the people living in the home to remain in contact with their families. The outcomes of visits to or from health care professionals must be clearly recorded and conveyed to staff appropriately. This will ensure staff have all the information they need to care for people appropriately. Receipts for purchases made on behalf of the people living in the home should include the details of what was purchased. This will ensure people are fully safeguarded. The issues raised in relation to general maintenance should be addressed to ensure the environment is kept to an acceptable standard for the people living there. Any restriction on access to personal clothing must be clearly documented to ensure this is not being done unnecessarily. Systems should be in place to ensure people can have privacy in their bedrooms. All areas of the home must be kept clean to ensure good infection control throughout. Staff should receive six supervision sessions per year so that their roles and responsibilities are reviewed and any individual training needs are identified to assist them to meet the needs of people who live in the home more effectively. The home should have a quality assurance system in place that details how the service is to be improved for the people there. Page 32 of 34 2 10 3 13 4 5 15 19 6 23 7 24 8 26 9 10 11 26 30 36 12 39 Care Homes for Adults (18-65 years) 13 42 Regulation 37 notifications should be sent to the Commission for any incidents that affect the well being of the people living in the home. This will ensure incidents are being managed in the best interests of the people living in the home. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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