Inspection on 20/02/06 for St Blaise Avenue (2)

This inspection was carried out on 20th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Blaise Avenue (2) 15/04/08

St Blaise Avenue (2) 06/06/06

St Blaise Avenue (2) 24/11/05

St Blaise Avenue (2) 13/01/05

St Blaise Avenue (2) 04/10/04

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Edenvale

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Chatsworth Care - Dawson House

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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 St Blaise Avenue (2) 2 St Blaise Avenue Bromley Kent BR1 3DA Lead Inspector Ann Wiseman Unannounced Inspection 20th February 2006 12:00 St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 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 St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 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. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Blaise Avenue (2) Address 2 St Blaise Avenue Bromley Kent BR1 3DA 020 8460 1851 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) Maxine.shawromley.gov.uk London Borough Bromley ** Post Vacant *** Care Home 5 Category(ies) of Learning disability (5) registration, with number of places St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered as a Care Home (CRH), with a service category of (PC) Care Home only, with a Service User Category of (LD) Learning Disability five (5), of both sexes, of which (LD(E)) Learning Disability over the age of 65, one (1). Registration is subject to the home complying with the Fire Precautions (Workplace) Regulations 1997 and the requirements as stated in the report submitted by the London Fire and Emergency Planning Unit dated the 21/07/03. 13th December 2005 2. Date of last inspection Brief Description of the Service: St Blaise is a two story semi-detached House in a residential road within walking distance of Bromley’s main shopping centre and is convenient for all local amenities and public transport. The home is part of the London Borough of Bromley’s care provision in the Learning Disability sector. The home provides support for five service users all whom have a learning disability; currently there are three male and two female service users. The home has its own manager and cares staff and will use Care Bank and Agency staff if the need arises. The Service Users in this home are supported in all their activities of day-today living to maximise their skills and to enable them to develop to their full potential. Friends and families are encouraged to participate in the in the Service Users lives and leisure activities. The house has a garden to the front with parking for two cars and a good sized back garden. Policies, procedures and recruitment are organised through the central office of London Borough Of Bromley. Senior staff management and staff support are provided through Bromley Borough. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, there were no Service Users at home when the Inspector arrived and the manager was not on duty, she was contacted the next day by phone. The visit lasted five hours and the Inspector had a tour of the building and was able to talk to three staff members, one of the Service Users and her Mother. The last Inspection was only two months ago and this will be acknowledged when assessing progress of Requirements and Recommendations from that Inspection. On inspecting the paperwork it is apparent that the new Manager, who is going through the process of registration at the moment, is beginning to make an impact and that she has started updating Care plans and organising practice and procedures. The home was clean and tidy, there was a relaxed atmosphere and it was homely although there was a general air of dilapidation with chipped and scuffed paintwork and walls in the communal areas and stained carpets in some of the rooms. There was a broken piece of furniture on the upstairs landing and some more pieces of it outside in the front garden by the bins that were full and overflowing. The condition of the front garden has not improved since the last inspection. Therefore the main first impression of the house is one of being run down and neglected. What the service does well: What has improved since the last inspection? What they could do better: The house and garden would benefit from a program of regular maintenance and redecoration, the wall by the front entrance is still broken and there are loose bricks and rubbish strewn about the garden. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 6 Disused furniture should be removed and disposed of immediately and the management of rubbish must be reviewed to enable all rubbish to be stored in a safe and hygienic way. Discussions with staff and Relatives indicate that communication within the home and with some of the relatives needs improvement. This is important as poor communication can have a detrimental effect on the smooth running of the home. 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. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None were assessed on this occasion This section has been assessed on a previous occasion EVIDENCE: The last inspection two months prior to this assessed these standards and found that that the information provided was good and of a high standard. Two Requirements and a Recommendation from the previous Inspection have been actioned. Care Manager have been contacted by the Manager requesting copies of the Service Users Community Care Assessments and assurance that copies will be obtained for any new Service User prior to their admission. Manager has now put in place a letter to inform all new service users of Panel agreement and to inform prospective client that the service can meet their needs. Service Users have a copy of the have their own copy of the Guide kept in their individual file. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All standards were inspected on this occasion. Care plans reflect the Service Users changing needs and personal goals. People are enabled to make decisions about their lives and to take risks as part of an independent life style. They are consulted on the running of the home and Service Users can be assured that information is handled appropriately. EVIDENCE: Care plans are in place and are detailed, all new care plans, reviews and risk assessments have been or will be amended to clarify dates written, updated and date for planned review inserted. All Service Users have a review meeting annually and personal goals and aspirations are discussed and documented. The Inspector saw evidence that Service Users take part in House Meetings that are recorded and discussed during Staff Meetings. The areas covered by the House Meeting included proposed outings and holidays, how the home was run, issues between service users and what behaviour they expected from each other. Some of the Service Users continue to travel independently and risk assessments were examined during the last inspection. Personal information is stored in the sleep in room in a locked filing cabinet. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion EVIDENCE: A recommendation made during the previous Inspection on 24th November 2005 was that an activity plan should be drawn up that indicates what planned activities there are for service users and indicate whether it took place or not. The action plan drawn up in response states that “consultation is taking place with Service Users on what activities they would like to take up and will be completed in March 2006. Then individual activity programs will be drawn up and used in conjunction with their community participation record sheet.” St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 were examined during this inspection. Concerns were voiced to the Inspector, by Service Users family members, prior to and during the Inspection about worries that their daughter was not receiving the appropriate support to access healthcare. EVIDENCE: The Inspector focused on this area during this Inspection due to discussions with the family of one of the Service Users living at St Blaise. They raised concerns that their daughter was not receiving personal care in a way that was appropriate to her needs, that she had not been supported to access basic healthcare and that communication and recording information within the home is poor. Staff interviewed also felt that communication within the home and with Service Users families can on occasion breakdown. The issue of personal care was addressed during the previous Inspection and the Inspector has found evidence that referrals have been made to gain specialist support and that discussions as to how to best manage the situation has taken place within the staff team. Outcomes in this area will be examined during future Inspections. Another concern was that the Service User has not had her basic health needs addressed, for example ophthalmic and dental checks, and that this lack of St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 12 care has had a detrimental effect on the Service Users health. This issue has now become subject of a formal complaint, that will be followed closely by the commission. The Inspector looked for evidence that routine health checks were offered to the Service Users at St Blaise. It was indicated by means of appointment cards, comments in communication books and notes in the diary that there had been some dentist, chiropodist, optician and various doctor and hospital appointments undertaken. It was not possible to judge whether they are routinely carried and at what intervals as they did not appear to be recorded in any formal format. Discussion with staff members indicated that they are aware of the importance of supporting Service Users to attend healthcare appointments and of recording the outcomes and following up treatment and recommendations. It is important that clear records are kept of all appointments and that everyone is made aware of any guidance given and of actions resulting from the appointment. Recording should be robust enough to diminish the risk that future appointments and referrals are lost in the event of the key worker changing or staff member leaving. It is a requirement that practice and procedures are reviewed to ensure that basic healthcare needs are met. Please see Requirement 1 The medication cabinet and records were examined and was found to be order. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Both standards were examined on this occasion. Procedures are in place to allow Service Users and interested parties to make a complaint and to raise issues of concern. The Commission has been approached by a family member raising doubts of it’s effectiveness. EVIDENCE: A family member has approached the Commission, firstly informally and then formally raising concerns about the way their comments and complaints were handled. This issue has now become subject of a formal complaint to be investigated by the home, which will be followed closely by the commission. The Inspector found reference to a complaint in writing that one of the Service Users has made to her key worker regarding her unhappiness at the treatment she has received from another Service User. However no other reference was found of the complaint and there was no evidence that it had been actioned. On enquiry the Manager assured the Inspector that the complaint had been taken seriously and that it would be followed up. It is a requirement that the commission in informed of the investigation and it’s conclusion. Please see Requirement 2 The house now holds policies in relation to adult protection, a requirement from the previous Inspection. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 were assessed on this occasion. The home has a comfortable but rundown appearance. The bedrooms were of a reasonable standard and reflected the needs and lifestyle of the Service Users. EVIDENCE: It is a previous recommendation that the garden, front and back, should receive attention, the inspector has seen evidence in team meeting notes that quotes have been given for work to be carried out and the Manager has assured the Inspector that work was planned to take place in the spring. This recommendation will be restated with the added recommendation that the needs of rubbish disposal should be considered especially as to whether there are sufficient bins to hygienically contain rubbish generated by the home, rubbish must not be left by the bin. Please see recommendation 1. Disused and broken furniture was left on the first floor landing and also by the bin in the front garden. Arrangements should be made to dispose of unwanted furniture immediately. Over all the house was clean and tidy, however carpets throughout the house and in two of the Service Users bedrooms are stained and dirty and need cleaning or replacing. Please see Recommendation 2 The house would profit from a program of redecoration and this should be considered. Please see Recommendation 3 St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: The Manager has assured the Inspector that a Requirement from the previous Inspection regarding the necessity to hols staff information as set out in schedule 2 has been fulfilled. Evidence will be sought at the next Inspection. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 were assessed on this occasion. The Manager is beginning to make an impact on the home and staff interviewed said they had confidence in her and felt she was supportive. EVIDENCE: The Manager has begun the Registration process through CSCI. She appears competent and organised. Staff interviewed felt that she was supportive and fair. They confirmed that she gave regular supervision. There is evidence that the Manager has begun to organise and review the house practice and procedures and has begun to update Service User information. The Health and Safety of the Service Users has been protected, there are no obvious dangers to the Service Users; cleaning materials are locked away, radiators are covered, water temperatures are regulated, fridge and freezer temperatures are checked and recorded etc. A sample of records were inspected and found to be up to date. A copy of the COSSH assessments has been placed in the cupboard with the cleaning materials, a previous Requirement. St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 17 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 X 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X X X X 3 X St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA19 YA22 Regulation 12 33.3 Requirement Practice and procedures are to be reviewed to ensure that basic healthcare needs are met. The Manager will inform the Commission of the progress of one of the Service Users complaint. Timescale for action 15/05/06 15/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA30 Good Practice Recommendations A maintenance program should be put into place to keep the grounds and gardens better maintained, also the needs of rubbish disposal should be considered especially as to whether there are sufficient bins to hygienically contain rubbish generated by the home, rubbish must not be left by the bin. Carpets throughout the house and in two of the Service Users bedrooms are stained and dirty and need cleaning or replacing. The house would profit from a program of redecoration and this should be considered. 2 3 YA30 YA24 St Blaise Avenue (2) DS0000038974.V278179.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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