Inspection on 26/04/06 for Tavistock Avenue (12)

This inspection was carried out on 26th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Tavistock Avenue (12) 11/04/07

Tavistock Avenue (12) 25/01/06

Tavistock Avenue (12) 18/08/05

Tavistock Avenue (12) 21/01/05

Tavistock Avenue (12) 20/10/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Tavistock Avenue (12) 12 Tavistock Avenue St Albans Hertfordshire AL1 2NH Lead Inspector Mrs Jan Sheppard Unannounced Inspection 26th April and 6th June 2006 13.00 Tavistock Avenue (12) DS0000019562.V290649.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 Tavistock Avenue (12) DS0000019562.V290649.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. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tavistock Avenue (12) Address 12 Tavistock Avenue St Albans Hertfordshire AL1 2NH 01727 850 215 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) Cherry Tree Housing Association Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2006 Brief Description of the Service: The home, known as 12 Tavistock Avenue is a semi-detached house in a quiet residential area of St. Albans. It is situated close to local amenities and provides personal care and accommodation for three people. These residents each have their own individual single bedrooms and share the lounge, dining room, bathroom and laundry room. There is a pleasant domestic style kitchen that overlooks the secluded rear garden and patio area. Staff have a small office and sleeping accommodation on the first floor. There are small gardens with off street parking to the front of the property. The home, which is run by Cherry Tree Housing Association, offers homely and safe accommodation and full care services for its residents who all have learning disabilities. The current fees for the residents who are all sponsored by Hertfordshire County Council are £780.44 gross per week. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The homes new manager is Ms. Janet Dean. being processed by the Commission. Her application for registration is This unannounced inspection took place over one afternoon and early evening and then included a short follow up meeting to gain extra information. Both the residents and all the staff on duty were spoken with along with the homes Manager. The comments in this report reflect the findings made by the inspector during those times and also take account of information gathered since the last inspection. Twenty-Five standards were examined during this inspection. All of the requirements made following the last inspection have been met. One requirement is made following this inspection. On the day of this unannounced inspection the home had a calm and peaceful atmosphere and the residents seemed contented and settled and were obviously at ease with the staff. They told the inspector that they were happy with their life style and that they liked living in the home. What the service does well: What has improved since the last inspection? What they could do better: More detailed records of the staff’s spontaneous consultation discussions with the residents should be kept. So service users are not put a possible risk all staff must be trained to administer medication – this includes agency staff. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 6 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. Tavistock Avenue (12) DS0000019562.V290649.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 Tavistock Avenue (12) DS0000019562.V290649.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): 1,2,3,4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has policies and procedures that meet the requirements of these standards, for the needs assessment of new residents and appropriate visiting arrangements for their gradual introduction to the home. EVIDENCE: No new residents have been admitted to the home since the last inspection; the home currently has one vacancy. The last new resident admitted to the home during December 2005 following a crisis situation was found not to have been appropriately placed and has moved to another service where his needs can be more appropriately met. Both the existing residents have the required information about the home, including a Tenancy Contract, a Statement of Terms and Conditions and the Service Users Guide. Both residents confirmed that prior to their admission to the home they were able to make a number of visits including staying visits to enable them to make an informed choice about admission. It has been acknowledged that the last new residents admission was not made following all the appropriate procedures, insufficient background information was gathered from social services and not enough time was allowed for introductions to be effective with the existing residents. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 9 The Manager discussed with the Inspector the measures that she intends to put in place to ensure that this pattern was not repeated. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Detailed and quality care plans are maintained for each resident. Appropriate procedures are in place to ensure the safety of the resident both inside and outside of the home. The residents are given every encouragement to make as many decisions about their own lives as it is safely possible for them to do. EVIDENCE: Both care plans were examined and were found to be very well maintained with good detail as to how care needs should be met in a manner which coincided with the wishes of the individuals concerned. Recent changes to their care needs were seen to be recorded along with change details as to how these new needs should best be met. Regular reviews for both plans were appropriately recorded with future review dates noted. Risk assessments for activities both internal and external to the home were found to be maintained up to date with realistic aims and goals, which help promote the independence of the resident. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 11 Where necessary the detail of these risk assessments and the degree of risk associated with the activity had been shared with the residents social worker the day care activity staff and with their relatives. The manager explained that being a very small home where staff and residents talk freely together continually, it is not appropriate to have formal residents meetings as issues are dealt with and consultation occurs spontaneously as situations arise. These discussions often occur during the homes evening meal when staff and residents eat together. Appropriate ways of recording these spontaneous discussions and decisions arrived at were discussed with the inspector. Improvements could be made to the detail of this recording as it is important to be able to audit how a decision or request has been addressed. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents both have day centre activity programmes, which offer them the opportunity for personal development alongside peers of a similar age and ability. The residents frequently participates in activities and events held in their local community. Both residents have frequent contact with relatives and friends outside of the home. A nutritious and varied menu, chosen by the residents is offered with fresh ingredients and home cooking being provided on a daily basis. EVIDENCE: Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 13 There have been no changes to the meal planning arrangements since the last inspection. The residents and staff plan the menus on a weekly basis to give variety and choice, to take account of the residents likes and dislikes as well as the need to adhere to a healthy eating programme. Residents help the staff with the purchasing and preparation of the food. Until this month the home has received a quarterly visit from a Dietician who has overseen the menu planning and has monitored the residents weights. However the visiting Dietician service in this area of Hertfordshire has been disbanded with the dieticians made redundant. Over the past year both the residents have lost weight following a healthy eating plan and are now considered to be of a normal weight for their age and height. One resident told the inspector that they had lost a stone and proudly showed off their new clothes! The stocks of food in the fridge /freezer were found to be kept with appropriate labelling and with the equipment maintained at the correct temperature. A bowl of fresh fruit was seen to be available and the residents spontaneously accessed this, and took yogurt from the fridge, as a teatime snack when they arrived home from their day activities. The residents both attend day centre or college classes on three weekdays and both have either regular religious or sporting activities or family visiting arrangements for the weekends. One resident discussed with the inspector the visits and outings they plan to go on with their Day Centre Group over the summer months. They also explained that they like to use their free bus pass to go on bus journeys into the countryside. The other resident talked of their gardening activities at the Earth Works Centre. “I do like digging“, they said. At Earthworks they are a member of a group who go out into the community to help elderly persons maintain their gardens. They also told the inspector that he continue to make their own way to college in the mornings on the bus where they are accompanied by another student who lives near by. They said that they very much enjoyed the new college class, attending the gym; an activity they think has helped with weight loss. Both residents discussed their forthcoming holiday on the Isle of White. They explained that they had chosen to return to the same place they visited last year as they had enjoyed that visit very much and wanted to return, as there remained several locations on the island that they still wished to explore. A risk assessment for this holiday was seen to have already been completed. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Personal Care and Health Care offered to the residents continues to be of a high standard. The home has a robust medication storage and administration system, which apart from one recording error was found to be well maintained. EVIDENCE: Personal care was seen during this inspection to be being delivered to the residents in a kind and understanding manner by staff who clearly understood their care needs, both physical and emotional, thoroughly. One careworker clearly knew just when to reassuringly intervene with one resident who became somewhat anxious, this done in a manner which promoted their independence and feeling of well being. The home benefits from having well established professional working relationships with their local GP, the community nursing team and with various specialist Consultants at local hospitals, this ensuring that any changing health needs can be quickly met. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 15 The records evidenced, and staff confirmed, that the frequency of attacks suffered by one residents had very considerably decreased since their admission to the home this to the amazement of his Doctor. There have been no changes to the medication administration system since the last inspection. Records of the medication entering and leaving the home are checked in and out by 2 staff with appropriate records kept. One omission on the MAR administration recording sheet made by an agency member of staff, was seen to have been noted and investigated by the homes manager during her regular checks of the records, and further training had been given. It is recommended that the manager obtains evidence from the Agency of the medication training completed by the staff before they commence work in the home. The medication was found to be properly stored in a small metal drugs cupboard. The inspector reminded the staff of the necessity to check that any liquid medication is stored at the correct temperature and where it is necessary for items to be kept in the fridge then an appropriate locked metal container is used. The home does not have a controlled drugs cupboard. No controlled drugs are currently being administered in the home. To meet the pharmaceutical guidelines consideration should be given to how a controlled drugs cupboard can be obtained in an emergency. It may be necessary to install such a cupboard now and be prepared rather than wait for an emergency to arise. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality and outcome in this area is good. This judgement has been made using available evidence including a visit to the service. The home has a complaints policy and procedures and also has policies and procedures concerning Adult Protection and Whistle Blowing, which follow the guidelines given in the Hertfordshire Adult Protection Joint Agency procedures. EVIDENCE: There have been no incidents concerning Adult Protection since the last inspection. Staff spoken with had a sound understanding of this and several said that they had undertaken further refresher training on this subject since the last inspection. One complaint made prior to the previous inspection was seen to have been investigated and has now been resolved. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 17 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 and 30 Quality in this area of outcome is good. This judgement has been made using available evidence including a visit to the home. Number 12 Tavistock Avenue provides a homely, safe and comfortable environment where the accommodation meets the residents physical/social needs and the facilities provided are suitable to enable the appropriate care to meet their assessed care needs to be given. EVIDENCE: Since the last inspection various works of redecoration and refurbishment have been carried out, or works are planned and equipment on order and these measures meet the environmental requirements made during the last inspection. Redecorations in one bedroom and on the stairs and landing have greatly improved the internal appearance of the home. New soft furnishings and colours of throws and cushions in the lounge have given this room a more homely and well cared for appearance. The home and garden are well maintained and the manager demonstrated an awareness of an area (the kitchen store units and decoration) that will require attention in the future. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 18 A gardener visited the home to cut the lawns during the time of this inspection. The manager explained that the landlord had agreed to repair the front garden fence and an air conditioning unit had been ordered for one bedroom. Both residents told the inspector that they were happy with their rooms inviting her to visit them, and they confirmed that they had all the equipment and storage facilities that they required. Neither of these bedrooms has an individual wash hand basin. Both the residents commented on the recent improvements (upgrading of equipment power shower) in the bathroom and said how they liked using this. Extra grab rails have also been provided this to ensure the safety of one resident. Consideration is being given to replacing the tumble dryer, which recently does not appear to have been working efficiently. On the day of this unannounced inspection the home was found to be clean, hygienic and tidy with no unpleasant odours. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 19 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): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home continues to retain a stable group of experienced and 100 qualified staff who work very well together as a team and are particularly dedicated to offering the best possible care for their residents. EVIDENCE: The care staff group is very stable and there have been no changes since the last inspection. It was not therefore required to examine the homes recent recruitment records. However the home has the required recruitment policies and procedures in place to ensure the safety and protection of the residents and these were known to have been followed for previous staff appointments. The home is adequately staffed and only very exceptionally has to use agency staff. Staff told the inspector that they were very well supported by the homes management and that they received regular supervision and had good opportunities to attend training. These comments were all evidenced by the homes records, which were examined during this inspection. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 20 Since the last inspection staff had attended various training including courses on Loss and Change, Manual Handling, First Aid, Food Hygiene, Adult Protection, Epilepsy, Medication Administration and Active Listening Skills. All the staff who work at this home have attained an NVQ at level 2 and several have also completed Level 3.They have all had several years experience working with this client group. The homes Manager are part way through the NVQ level 4 Registered Managers Award. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home is well run and has a very dedicated staff team. Close consideration to the health and welfare needs of the residents is given and this results in a warm caring environment where the residents are able to freely express their feelings, wishes, likes and dislikes. EVIDENCE: All the staff spoken with confirmed that they continue to be well supported by the homes management and that since the last inspection morale in the home had improved. One said, “we have got back to how things used to be and I am very happy working here”. The records relating to Regulation 26 visits and Regulation 37 notifications are properly made with copies for information sent to the Commission. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 22 The accident and incident records were examined and the Fire testing records evidenced that fire awareness, appliance testing and evacuation procedures are taken seriously in this home. The Manager discussed with the inspector the homes Quality Assurance Report and Development Plan, which had been provided by Cherry Tree Housing Association. Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x x 3 Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 24 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 YA20 Regulation 13 (2) The home must satisfy its self that all agency staff who administer medication are adequately trained and are competent to administer medication in this home. Requirement Timescale for action 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tavistock Avenue (12) DS0000019562.V290649.R01.S.doc Version 5.1 Page 26 - 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. 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