Inspection on 18/08/05 for Tavistock Avenue (5).

This inspection was carried out on 18th August 2005.

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). 12/06/06

Tavistock Avenue (5). 06/12/05

Tavistock Avenue (5). 07/12/04

Tavistock Avenue (5). 27/07/04

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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 12 Tavistock Avenue 12 Tavistock Avenue St Albans Hertfordshire AL1 2NH Lead Inspector Jan Sheppard Announced 18 August 2005 10:00 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 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 Stationary 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. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 12 Tavistock Avenue Address 12 Tavistock Avenue St Albans Hertfordshire AL1 2NH 01727 850215 Telephone number Fax number Email 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 LD Learning Disability - 3 registration, with number of places 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 21 January 2005 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 have their 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. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of this inspection year and took place over one half day when residents and staff were spoken with, records examined and a tour of the building undertaken. The detail in this report reflects the findings at that time and also takes account of the comments made by the residents, relatives and stakeholders in the home who completed pre inspection questionnaires. The inspector was welcomed into the home by both the staff and residents. She was able to speak individually with all the residents and with the staff who were on duty, and also spoke with the Director of Care for Cherry Tree Housing Association. Since the last inspection one of the residents has left the home and a new manager has been appointed following the retirement of the previous manager. The requirement and recommendation made during the last inspection have been met. On the day of this inspection the home had a very relaxed atmosphere and a homely appearance. The residents appeared to be happy they were stimulated and occupied and were obviously very at ease with the staff. What the service does well: 12 Tavistock Avenue offers a warm secure and homely environment for its residents with facilities and equipment that are appropriate for their physical and emotional needs. Both the residents appeared to be relaxed and happy and to be very much at home in their own personal spaces. Staff were observed to be delivering care in an enabling manner and to be encouraging them through prompting to take as much responsibility for their own life style as it is safely possible for them to do. Being a very small home the staff are able to give the residents a lot of personal attention any issues that arise can be attended to promptly and the staff have very sound knowledge of the residents individual care needs and how these can best be met. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 6 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. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 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 standard(s) 1,2 and 5 Appropriate information in the form of the Statement of Purpose and Service Users Guide is available for the service users and their families concerning how the home operates and what procedures are in place to meet their care needs. This document needs to be updated to accurately reflect the recent staffing changes in the home. EVIDENCE: The home has a pre-admission policy and assessment procedure that meets the requirements of this standard. As no new residents have been admitted since the last inspection it has not been possible to examine the operation of this admissions procedure any more fully. However the most recently admitted new resident spoke to the Inspector saying that he remains very happy in the home and a relative visiting him confirmed that this is so. The contract statement of Terms and Conditions given to every new service user gives details of their room, the fees payable, the care and services that they will receive and the terms and conditions of their occupancy including their rights and obligations in the event of any breach of contract. At the time of this inspection the home had a happy and relaxed atmosphere and staff were meeting the needs of the residents in a caring and understanding manner. The care plans showed that the residents changing care needs and aspirations are recorded and that risk assessments were also in place. However, see comments on page 10. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 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 standard(s) 6,7 and 9. Personal care and assistance offered to the service users is of a high standard and is delivered in a manner that maintains their dignity and respect. Comprehensive and imaginative care plans are kept although in recent months the frequency of the pattern of reviewing these has slipped somewhat and a regular pattern for reviews needs to be re-established. Risk assessments are maintained for the residents and these reflect how potential risks for some individual residents can best be avoided or managed as safely as possible. EVIDENCE: The care plans were found to be well organised and to give clear and concise instructions as to how care should be delivered. The detail of these was found to be closely following the suggestions made at the previous multi disciplinary review meetings. Where possible families or friends were involved in these reviews when risk assessments were also re considered. It is a requirement that all residents have an annual care plan review to ensure that their changing care needs can be met fully and promptly. The records relating to the residents meetings evidenced that they are involved in as many of the decision making processes concerning the running of their home as it is safely possible for them to so be. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 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 standard(s) 12,13,15,16 and 17. The residents day centre activity programmes offer them the opportunity for personal development and recreation alongside peers of a similar age and ability. Weekend and evening activities are organised by the staff but more staff hours available at the weekends would enable this programme to be more comprehensive. The residents maintain close relations with friends and relatives to whom they often make day and staying visits. A nutritious and varied diet chosen by the residents and supervised by a dietician is offered with fresh vegetables and home cooking being provided on a daily basis. EVIDENCE: The two residents both have day centre activity programmes covering four days each week. The fifth day is spent in the home completing domestic chores, laundry and paying bills for board and lodging etc. The activity programmes are planned to meet their individual interests and abilities and also to help them maintain and develop further their daily living skills. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 11 One resident attends a number of college classes and said that he was looking forward to the commencement of the next college year. Both residents told the inspector that they enjoy their day activities and that they have both made friends amongst the other attendees/students. One explained that his gardening activity for the “Earth Works” organisation has recently resulted in a sale on a local market stall with the proceeds being divided between the workers. Staff told the inspector of the in-house, “Independence project” that they are following with one resident to help him to further develop such areas as road sense the use of public transport and posting letters. Both the residents frequently go out into the local town and use local leisure and other recreational facilities of their choosing. During the earlier summer months both residents enjoyed a weeks holiday to the Isle of White, which was said by the staff to have been a very successful and happy time. The residents rights and choices were seen to be taken into account by the staff and it was noticeable that the residents also showed good awareness as to the rights of the staff in a mature and concerned manner. One parent who visited during this inspection to accompany their son to the dentist confirmed that he is very happy in the home and that she was impressed with the manner in which the staff was helping him to develop his social skills and to increase his self-confidence. The other resident told the inspector about his recent visit to family members in the Midlands and explained how the staff had helped him to remake connections with these relatives with whom he had had little contact for some years. He said that he planned to make another visit at Christmas and enjoyed keeping in touch with them by letter and post cards. One card that he had recently received from them was shown to the inspector. There have been no changes to the menu arrangements since the last inspection. Both residents confirmed that they have plenty to eat; dishes that they like and that they often help to prepare these. The inspector noticed that when the residents returned home from their day activities they had a snack of tea, yogurt and fruit which they freely accessed themselves from the fridge. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 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 standard(s) 18,19 and 20. The personal care and health care offered to the residents is of a high standard and is personalised to meet their individual needs and takes account of their wishes and preferences. A robust medication storage and administration procedures are in place. Only trained staff administers the medication. EVIDENCE: Individual personal care practice observed was commendable. The needs of the residents were seen to be being individually met by kind and sympathetic staff who intervened as little as possible thus ensuring the greatest level of selfdetermination for the residents. The staff confirmed that visits to the doctors or other health professionals are planned well ahead and are recorded in the daily record book. Relatives are given the opportunity to be involved if they wish, (one was seen to be so involved on the day of this inspection), otherwise staff would always accompany the residents to these appointments. There have been no changes to the homes medication system since the last inspection. The recently acquired medication storage cupboards are providing adequate space and the MAR sheets were seen to be accurately recorded to reflect the medication administered. All staff have received medication training and an adequate record of checks to the system and the administration records were seen to be being carried out by management. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 13 The manager discussed with the inspector the advantages of the MDS medication system and explained that she is to explore the possibility of changing to this safer system previous attempts to do this some years ago by the previous manager had failed because the supplying chemist had no capacity for extra customers. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 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 standard(s) 22 and 23 A complaints policy and procedures are in place, a copy of which is given to all residents and where possible to relatives and families as well. Policies and procedures are in place concerning Adult Protection and Whistle Blowing, which follow the guidelines given in the Hertfordshire Adult Protection Joint agency procedures. EVIDENCE: There have been neither complaints nor any incidents concerning adult protection since the last inspection. Staff were aware of their obligations concerning these areas and of the importance of them remaining diligent in keeping awareness for any nonverbal signs of distress or concern that may be exhibited by the residents. All the staff spoken with had undertaken training for this subject and the manager being new to her post in Hertfordshire commented that she is to attend training concerning the procedures in Hertfordshire joint agency guidance. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 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 standard(s) 24,25,26,27,28, and 30. This homely house and its surrounding gardens offer a pleasant, comfortable and safe environment for its residents, it meets their needs and suits their life style and fits unobtrusively into the community in which it is set. The home is clean and well appointed and has a planned routine maintenance programme. However at the time of this inspection a number of works of repair were required following a flood caused by a plumbing leak which had affected one bedroom and the kitchen. EVIDENCE: This home, an ordinary semi detached house, fits unobtrusively into its local community. It provides sufficient space and facilities to meet the needs of the current residents. It has a homely appearance and is well maintained being subject to a routine maintenance programme. The residents individual bedrooms were seen to be well personalised with furniture soft furnishings and pictures books etc. chosen by them to reflect their tastes and interests. One resident proudly showed the inspector the fitted cupboards that his family had recently helped him to acquire and said how much easier he now found it to keep his clothes in good order. The home is cleaned by the residents and staff and was found to be generally clean except for the carpets in some areas, which needed to be steam cleaned. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 16 Otherwise there appeared to be an appropriate awareness of hygiene and infection control measures by both the staff and residents. The water leak that had occurred on the day prior to the inspection had caused water and damp damage in one bedroom and in the kitchen. Problems also appeared to have developed with the boiler, which in turn had been causing excessive heat in one of the bedrooms, which had proved somewhat excessive during the hot weather for the resident concerned. Workmen were still making an assessment as to the full extent of the problems and of the damage caused and a programme of repair or refurbishment was being worked on with them by the Associations Director of Care. The possible relocation of the boiler was being considered. Requirements are made concerning these aspects. The manager discussed with the inspector the work that is about to commence to refurbish the bathroom. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35 and 36. The home is run by a very dedicated and well established staff team who are experienced and qualified. They all have job descriptions and clearly identified roles and responsibilities with in the home. The appointment of the new manager without any gap following the retirement of the previous manager has been advantageous for the home. EVIDENCE: The home is fully staffed and those on duty at the time of this inspection were seen to be working well together as a team. The staff appeared to be clear about their individual roles and responsibilities and told the inspector that they were very well supported by the homes management. The home has an excellent training record with the numbers of staff already holding the NVQ levels 2 or 3 qualification exceeding the requirements for this standard. Staff spoke positively of their many training opportunities and said that even though they had attained the levels required training was still ongoing. A recent specialist course in epilepsy care has proved beneficial and other courses recently attended included Food Hygiene, Sexuality Awareness, Mental health problems for those with learning difficulties, Manual Handling and Back Care and a course on Staff Supervision. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 The views and wishes of the residents are gained through their regular residents meetings and on a daily basis being a small home the general talk around the table at meal times is another effective and spontaneous method of gathering information and opinions. There is a good awareness of Health and safety issues with in the home demonstrated during this inspection by both the staff and the residents. EVIDENCE: On the day of this inspection the home was calm and settled with residents and staff eager to speak with the inspector and to catch up on the happenings within the home since the last inspection. The appointment of the new manager following the retirement of the previous manager has gone smoothly and without any problematic time delay. The new manager is experienced and competent and has fitted very quickly into her role and seems to be well accepted by both residents and staff. She told the inspector that she felt lucky to have joined a home where the staff were well qualified and experienced and 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 19 most being long standing workers at the home had very sound knowledge as to how the residents needs should best be met. The relationship between the residents and the staff is well balanced with interactions being observed to be both appropriate and supportive. The staff and managers of this home, and of its sister home 5 Tavistock Avenue, demonstrate a sound awareness of the homes achievements of the national minimum standards and the Director of Care for Cherry Tree Housing Association joined the final feedback session at the end of this inspection to discuss how the homes could further take forward their compliance in the meeting these standards beyond just the minimum requirements so as to enhance the quality of care delivered to the residents. 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 x 2 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 12 Tavistock Avenue Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 21 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 1 Regulation 6(a) Requirement The Statement of Purpose and Service Users Guide requires to be updated to accurately reflect the current position in the home. Care plans must be formally reviewed annually Air conditioning, or some other remedial measure must be taken to ensure that the heating levels in one residents bedroom (next to the boiler house), do not raise too high. To ensure the maintenance of good hygiene, carpets in areas subject to heavy wear, should be regularly steam cleaned Timescale for action by 31st October 2005. 2005 31st 2. 3. 6 24 15(2)(b) 23(2)(b) by 31st October by April 2006 4. 30 23(2)(d) by 31st October 2005 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 13&14 Good Practice Recommendations Consideration should be given to increasing the staffing hours at weekends so that more activities could be provided. I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 22 12 Tavistock Avenue Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City 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 12 Tavistock Avenue I52 s19562 12 tavistock avenue v235887 180805 stage 4.doc Version 1.40 Page 23 - 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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