Inspection on 12/06/06 for Tavistock Avenue (5).

This inspection was carried out on 12th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tavistock Avenue (5). 29/05/07

Tavistock Avenue (5). 06/12/05

Tavistock Avenue (5). 18/08/05

Tavistock Avenue (5). 07/12/04

Tavistock Avenue (5). 27/07/04

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 (5) 5 Tavistock Avenue St Albans Hertfordshire AL1 2NQ Lead Inspector Mrs Jan Sheppard Unannounced Inspection 12th June 2006 12.15 Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tavistock Avenue (5) Address 5 Tavistock Avenue St Albans Hertfordshire AL1 2NQ 01727 843545 01727 843545 FP 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 (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: The home is a two storey semi-detached house in a residential area of St. Albans. It is owned by Cherry Tree Housing Association and is situated close to the city centre with easy access to public transport. The ground floor comprises a lounge, a combined kitchen dining room, one bedroom, an assisted shower room and a laundry room. Two bedrooms, a bathroom and a staff office are located on the first floor. The home provides full care services in a safe and homely environment for three service users who all have learning disabilities. The current fees for the residents who are all sponsored by Hertfordshire County Council are £745.13 net, £807.48 gross, per week. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The homes new manager is Ms. Janet Dean. Her application for registration is being processed by the Commission. This was the first unannounced key inspection of this inspection year and took place over one half day. All the staff on duty and two of the three residents were spoken with. Discussions were also held with the Homes Manager and with the Director of Care for the homes owners, Cherry Tree Housing Association. The comments in this report reflect the findings made by the inspector during this inspection visit and also take account of information and reports that are periodically sent to the Commission by the homes manager. Twenty-three standards were examined during this inspection. The requirements made during the last inspection have been met. One recommendation is made following this inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 6 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 (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 7 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): 2 Quality in this outcome area is good. 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: As no new residents have been admitted to the home for more than five years and the home does not currently have any vacancies it is not possible to examine this standard in detail other than to confirm that the home has the required initial assessment policies and procedures with which staff are familiar. The existing residents have the required information about the home, including a Tenancy Contract, a Statement of Terms and Conditions and Service Users Guide. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 8 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. The home maintains detailed individual care plans for each resident, which were seen to reflect personal needs and aspirations. EVIDENCE: The care plans of all three residents were found to be well maintained up to date, with regular reviews of changing care needs and with appropriate risk assessments also seen to be regularly reviewed. Each plan contained numerous details as to exactly what the care needs were and how these should be met. In many instances a suggestion as to the manner in which staff could approach meeting these needs so as to encourage the resident to develop and maintain their own skills and potential was also clearly stated. A number of ways of enabling the residents to make as many decisions about their own life style as it is possibly safe for them to do are adopted by the home. Regular formally planned residents meetings are held for which minutes and appropriate records are kept. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 9 In addition the opportunities offered by the fact that the home, being a very small home, offers special opportunity for residents and staff to frequently sit together to eat and talk in a very homely and integrated manner are taken advantage of. These occasions provide good opportunity to discuss individually, and with the group as a whole, the homes day to day arrangements and future plans. The staff have recently commenced making regular notes of these discussions so that the items discussed and decisions spontaneously made are recorded and evidence of the residents contribution to these decision making processes can be seen. During this inspection the residents were heard to ably participate in these discussions with no apparent hesitation in making their views and wishes known to the staff. When the Director of Care unexpectedly visited the home from the Associations Head Office during this inspection he was closely questioned by one resident concerning a current issue and the inspector noted that the resident was not slow in putting forward her own suggestions. The residents appeared to be happy, stimulated occupied and obviously at ease with the staff. During this inspection the homes manager discussed with the inspector the recent review of one risk assessment relating to the use of an assisted chair in the lounge. It was noted that the risks that could occur if this chair was not operated carefully had been fully discussed with the residents. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 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): 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 day centre and attendance at other activity programmes offer them the opportunity for personal development and recreation alongside peers of a similar age and ability. Weekend and evening events in the local community are also enjoyed. The home offers a nutritious and varied menu chosen by the residents and supervised by a dietician, which offers fresh ingredients and home cooking on a daily basis. EVIDENCE: Since the last inspection the home staff have worked in conjunction with their local social services link social worker to re-plan day activity programmes for all the residents so that they meet their changed needs and compensate for classes given by the local college that are now no longer available to them. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 11 Each resident now has a comprehensive weekly programme covering four or five weekdays and including regular weekend activities which the two residents who discussed this with the inspector said that they were very happy with. The Pix and Mix Club and attendance at the Earthworks Project were mentioned as particularly well liked by the residents. One resident whose previous programme had, by her choice, been more limited has now settled happily into a different expanded programme this assisted by the coaching from the homes care staff who told the inspector that they could already see positive outcomes for the resident and that her social worker was working to further expand her programme. All three residents have regular contact with their families and friends, which include making regular staying visits to them over public holidays and at weekends. One resident told the inspector of a recent weeks holiday that she had shared with her parents during which she had celebrated her birthday. The homes group holiday this year was to Devon at the end of May, and was reported to the inspector to have been very enjoyable. The residents discussed with the inspector their plans to visit the London Eye later in the summer. The home continues to benefit from regular visits from the dietician who is assisting two of the residents with a weight reducing menu and another with a weight increasing programme. The homes staff appeared to have a good awareness of the need for a healthy eating programme especially as all the residents are said to “like their food “and to enjoy “eating out” and to have weekly “ take away” meals. The records of the weekly menus did not adequately reflect all the choices that are available or give good indication of what is actually consumed and it is suggested that more detailed records are maintained. The need for the monitoring of fluid intake was discussed by the staff with the inspector. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 12 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. The standard of care offered in this home is good meeting the physical and emotional needs of the residents. EVIDENCE: Personal care was observed to be being given in a calm kindly and unhurried manner by staff who were seen to anticipate the residents needs and yet delivered their care in a manner that enabled them to have as much responsibility for meeting their own care needs as it was safely possible for them to so do. The residents daily records of care evidenced that since the last inspection two of the residents have had a review of their changing medical needs and a revised plan of care had been set up by the hospital Consultants and specialist Doctors under whose care they remain. Very detailed notes concerning their medical care were seen to be kept on their care plans. There have been no changes to the homes medication storage and administration arrangements since the last inspection. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 13 The manager explained that as part of a review of their health care needs the medications prescribed for two of the residents had been changed, for one there being a considerable reduction to which she appears to be responding well. All the staff who administer medication have received the appropriate training. It is recommended that the home ensures, and has appropriate evidence to demonstrate, that any agency staff who work in the home have received similar training to enable them to properly carry out this role in the home. Where discussions had taken place arrangements for end of life care and funeral plans were seen to be recorded on some of the care plans. The records indicated that staff were aware for which residents this subject still needed to be discussed if or when a suitable occasion arose. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 14 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 in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a robust complaints procedure and follows the Adult Protection Procedures as set out in the Hertfordshire County Council joint Agency Guidelines. EVIDENCE: There have been no complaints nor any incidents concerning Adult Protection since the last inspection. Staff consulted demonstrated a good understanding of local adult protection procedures as well as an awareness of trigger points for them to maintain a keen awareness of whilst carrying out their caring duties. The homes records evidenced that Adult Protection training has been undertaken by all staff. The new arrangements concerning the changed involvement of the CSCI in the complaints process were discussed with the Manager and with the Director of Care. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 15 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 outcome area is good. This judgement has been made using available evidence including a visit to the service. The home, which is well maintained, provides a comfortable homely and safe environment for its residents. EVIDENCE: The accommodation provides an environment, which meets the physical and social needs of the residents in a very homely manner. The facilities provided are suitable to enable the appropriate care to meet their assessed needs to be given. On the day of this inspection the home was found to be clean and tidy. Each resident occupies a single bedroom these being appropriately furnished to meet their storage requirements and are personalised according to their choice in a manner which reflects their tastes and interests. The ground floor bedroom has its own assisted shower room whilst the two upstairs bedrooms share a good sized bathroom, which also has a shower facility. Neither of the first floor bedrooms has its own wash hand basin. The staff discussed with the inspector various changes to the arrangement of the furnishings in the communal areas which are to be made to give better access for the residents especially one whose mobility is somewhat limited. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 16 Plans for the ramping of the home, front and rear, to provide better wheelchair accessibility and extra storage provision for wheelchairs were also shown to the inspector. Since the last inspection a new non-slip floor covering has been laid in the kitchen. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 17 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, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a very stable staff group of well trained and experienced carers who all hold an appropriate professional qualification. EVIDENCE: There have been no changes amongst the staff since the last inspection. The home continues to retain a very stable and long standing staff group all of whom hold a qualification of NVQ at level 2. The homes records evidenced that all staff have an ongoing training programme this to ensure that their knowledge and skills are kept up to date. The records also evidenced that staff receive regular supervision and an annual appraisal. All staff spoken with confirmed that they continue to be very well supported by the homes management and have good opportunities to undertake further training. The homes recruitment policies and procedures ensure that the safety of the residents is protected at all times. The homes manager discussed with the inspector other procedures that should be followed, or checks made, when agency staff need occasionally to be used. This situation has recently arisen because of the extended period of sickness of one permanent staff member following an operation. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 18 The manager explained that only one Agency is used and that potential staff were able to make an initial visit to the home to familiarize themselves with the residents care needs and with the routines of the home. The Agency provides the home with evidence of training recently undertaken by the worker but it could not be evidenced that training in medication administration had been undertaken although the worker had said that she had done so. It is recommended that the homes Manager establishes her own in-house medication training format so as to assure herself that any agency staff employed have the necessary knowledge and skills to meet the medication administration needs of the residents in this home. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 19 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 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is well run by a stable experienced and well qualified management team. The home has an established routine of appropriate quality monitoring checks in place. The health and safety of the residents is promoted by the homes good maintenance of its safety checks and procedures. EVIDENCE: The homes new manager has applied for registration with the Commission, she is part way through the course for qualification at NVQ Level 4 the “Registered Managers Award”. Staff reported to the inspector that the home operates very smoothly with good team working amongst the staff. Residents confirmed that the home is “a happy home” where they felt that their needs are well met. One told the inspector “I like living here”. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 20 The homes records concerning health and safety evidenced that regular checks are undertaken and appropriate action promptly arranged to rectify problems. A plumber was working in the home on the day of this inspection testing the temperature regulation to the hot water for the ground floor shower; this was later found to be within acceptable limits. The manager discussed with the inspector the recent measures undertaken to alert the residents concerning the dangers of fire and of the necessity of routine fire testing and alarm routines within the home and the importance of practicing for an emergency. All the residents attended, on 10th May last, a fire safety training course run by the Hertfordshire Fire and Rescue Service. Questionnaires are used to gather feedback from residents, relatives and professional stakeholders in the home concerning the quality of service being provided. The owning Housing Association prepare an annual business plan and a report on the home outlining achievements made during the past year with plans for further intended goals during the coming year stated. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 21 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 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 2 36 3 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 3 x x 3 3 x x 3 x Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 YA35 Good Practice Recommendations It is recommended that the home establishes its own inhouse training programme concerning medication administration to be used when agency staff are responsible for this aspect of residents care. Tavistock Avenue (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 23 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 (5) DS0000019561.V297660.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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