Inspection on 18/10/05 for The Avenue

This inspection was carried out on 18th October 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

The Avenue 25/02/10

The Avenue 26/10/09

The Avenue 28/04/09

The Avenue 20/06/07

The Avenue 25/01/07

The Avenue 20/03/06

The Avenue 22/02/05

The Avenue 17/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Avenue 6 The Avenue Keynsham Bath & N E Somerset BS31 2BU Lead Inspector Sarah Webb Unannounced 18 October 2005 10:00 th 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. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Avenue Address 6 The Avenue Keynsham Bath & N E Somerset BS31 2BU 0117 9864700 0117 9862524 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) Keynsham & District Family Mencap Home Mrs Helen Barbara Hill PC Care home 8 Category(ies) of LD Learning disability (8) registration, with number of places The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 8 persons aged 19 - 64 requiring personal care only. May accommodate one named person aged 65 years and over. Will revert when named person leaves. Date of last inspection 22-Feb-2005 Brief Description of the Service: The Avenue is a large four storey, semi-detached, property situated in Keynsham. It provides accommodation for eight people aged between 18 and 64 years of age who have learning difficulties. One service user is over the age of 64 and there is a specific condition of registration in place for this named person. The house has a basement flat that provides accommodation by way of a selfcontained living area. This comprises of two single bedrooms for two service users, a bathroom and small kitchen. The first and second floor of the house provides accommodation for six service users.The home is within easy access of local amenities that include a leisure centre, shops and a park. There are accessible transport routes to both Bath and Bristol by both bus and train. There is also a mini van for service users use. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as an unannounced inspection and took place over a period of 1 day and an evening covering a total of 6 hours. The inspection methods used included record checks, case tracking, tour of some areas of house; and discussion with 2 of the staff team. All service users were met during the course of the inspection; those not seen on the day were met on an evening visit, as was the manager. What the service does well: What has improved since the last inspection? All three requirements have been met: The flooring has been replaced in the first floor bathroom. The chemical substance inventory has been updated with specific chemical data sheets. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 6 All staff have two written references prior to being employed. 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. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 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 The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 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) 2 The needs and preferences of each person are assessed before admission. EVIDENCE: There have been no new service users admitted to the home since the last inspection. Observation of relevant records evidenced that the last person, who was admitted in 2004 went through a specific admission procedure. This included an assessment of their needs by social worker, and discussion with the individual, family, and other health care professionals in order to obtain appropriate information. There was also documentation in place evidencing that all previous service users are funded by the local authority and had been admitted to the home through the care management process. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 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, & 9 There is a clear and consistent care planning system in place to adequately provide both staff with the information they need to satisfactorily meet individual needs. The home encourages individuals to make decisions regarding their lifestyle. The home’s risk management procedures in place ensure service users are supported safely in taking risks. EVIDENCE: Care planning continues to be up to date, reviewed regularly, and with clear instruction setting out how individuals are to be supported. An independence training file includes information relating to personal programmes, social interaction, living skills, and road crossing. Other records kept include areas of personal details, licence agreement, and inventory. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 10 Key workers review care plans on a monthly basis. Individuals’ families are invited to attend review meetings. It was evident through discussion with staff and observation of individuals’ records that people are supported to make decisions and choices about their lifestyle. One person had made a decision to change their work placements having been given the appropriate information. Those individuals spoken with during an evening visit said they made decisions about holidays and social events. There were comprehensive risk assessments in place that had been reviewed. These covered all aspects of peoples’ lives and evidenced that all risks recorded are considered reasonable and outcomes are achievable as part of a fulfilled lifestyle. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 11 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, 14, 15 & 17 The home offers individuals opportunities to lead active and fulfilled lifestyles which are both age appropriate and reflect their levels of independence. The home offers opportunities for individuals to take part in appropriate social and educational opportunities in order to enhance their lifestyle. The home supports and maintains residents with their personal and family relationships. The meals in the home offer variety and encourage service users to be aware of healthy eating options. EVIDENCE: There has been no change in that all service users are supported in accessing meaningful and varied activities during the week. This includes a mixture of work experience and employment, and access to day services, college placements, and a local drop in centre. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 12 Service users continue to access the local community such as visits to local shops, post office, library and the local leisure centre on a regular basis. An agreed decision has been made for a hairdresser to call on the home due to the cost incurred in using the local hairdressers regularly. The home’s mini bus continues to provide transport for service users to visit clubs, trips and holidays. The occasional taxi is used for appointments; buses are used on a regular basis to get to work experience and work placements. The home has supported an individual in continuing their day placement with a change to their transport needs. Individuals related their holiday and leisure experiences such as visits to Euro Disney, a cruise, horse riding and photography. It was evident through discussion with both staff and service users that families and friends continue to be are invited to the home for differing social occasions. The home has continued to follow a low fat healthy eating plan and continues to have systems in place to record meals offered and in involving service users in making choices through this plan. Those individuals spoken to said they liked the food offered; they said they also have takeaways such as Chinese food and fish and chips. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 13 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 & 20 Those individuals who need support with personal care receive this support in the way they prefer and require. The physical and emotional health needs of individuals are well met with evidence of multi disciplinary working taking place regularly. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure medication needs are met. EVIDENCE: The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 14 Three people continue to be supported with their personal care as recorded in their care plan. A service user’s mobility continues to be supported through hydrotherapy sessions. The home is also investigating other therapeutic interventions for this person with the support of GP. It was evident from documentation that the staff continue to monitor any changes to their mobility. Discussion with individuals evidenced that they are encouraged and involved in making choices when buying clothes. It was evident through discussion with service users and staff that individuals’ health care is well monitored. Documentation evidenced that individuals continue to be supported through specialist services such as psychiatry, podiatry, physiotherapy, and other relevant community health services. There are 4 individuals who are supported with the administration of their medication; two people self medicate and there were records of individual risk assessments in place for their own administration. Medication is administered through the Boots monitored dosage system, and is kept secure. All service users sign for their medication, which in turn is countersigned by a member of staff. Records held for were well maintained. There are procedures in place for those individuals who visit their families for overnight stays. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 15 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 & 23 The home has a satisfactory complaints system with evidence that service users’ concerns are understood and acted upon. Arrangements are in place for protecting individuals from possible risk of financial abuse. The home needs to review procedures for action to be taken in relation to an individual who presents behaviour that challenges. EVIDENCE: There is a complaints policy and procedure displayed. There have been no complaints since the last inspection. All service users have a copy of the home’s complaint procedure that is in pictorial form. The home has an abuse guidance policy in place setting out action to be taken in relation to a disclosure of abuse from a service user. Staff have been trained in the protection of vulnerable adults and discussion was had with two staff regarding the appropriate procedure to follow. Since the inspection the manager has received an updated copy of the B&NES Inter Agency Vulnerable Adults policy and has reviewed the home’s policy in order that both link in with each other ensuring a consistent approach is taken. Observation of an individual’s records, risk assessments and discussion with staff, identified that a person who occasionally displays behaviour that challenges, is supported by specialist services. It was evident through observation of their care plans that the home has worked well with this The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 16 individual and progress has been made in many areas of their personal development. Currently the home does not have a restraint policy as the incidents have been dealt with, without any form of physical restraint. However through observation of the recording of recent incidents it is evident that there have been occasions when this person’s behaviour has resulted in the possible threat of aggression being directed to both staff and other service users. A requirement is made for the manager to review the current procedures; ensuring there is a reactive strategy in place that instructs staff in appropriate action to take if the behaviour escalates in order to ensure the protection of all individuals from possible harm. There are procedures in place in supporting individuals in managing their finances; individuals’ financial procedures are recorded and kept secure. The records of cash held in safekeeping were consistent with the balances held. There are control measures in place for staff to check monies. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 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 standard(s) 24 The décor of the home provides a homely and comfortable environment. The home needs to improve in providing a safe and suitable external environment to meet the needs of individuals. EVIDENCE: The home is a large, four storey, semi -detached stone-built, property situated in the community of Keynsham. The external appearance of the home is in keeping with neighbouring properties. Local amenities include a leisure centre, shops and a park. There are accessible transport routes to both Bath and Bristol by both bus and train, and there are bus routes to other local areas. The home has a 5 year cyclical maintenance programme setting out the redecoration of bedrooms that is the responsibility of the home. Monthly inspection reports are sent to both the Commission for Social Care Inspection and the Bristol Churches Housing Association who is responsible for all external repairs. These reports are comprehensive, detailing all aspects of The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 18 both internal and external repairs required, including the replacement of missing masonry, repointing of many areas of the stonework, and investigation of cracks in the stonework. Some of these repairs that are needed go back to 2003 and 2004. The manager has tried on many occasions to instigate repairs, and has been in discussion in the past with the housing association regarding cyclical maintenance and feels she is not able to come to any agreement in relation as to how and when these repairs may be completed. The manager said that Bath and North East Somerset are currently in discussion with the home regarding the need for improvements to be made to the property in order to continue to meet the needs of the existing service users as they become older and for them to remain at the home. The manager also pointed out that elderly relatives now also have difficulty with visiting, as not all areas are accessible. Plans are in the process of being drawn up for a side extension to be built; this would include wheelchair accessibility and an external lift to the front door. Proposed plans also include a ground floor bathroom and internal stair chair. The manager explained that these improvements would need to be funded privately. The majority of the areas of the home were found to be decorated to a good standard, comfortably furnished and homely in appearance. Since the last inspection, carpets have been replaced throughout the communal areas of the home. The laundry room has a new fire door in place. The basement bathroom flooring has also been replaced. Three peoples bedrooms have been decorated. Those service users spoken to said they were pleased with their newly decorated bedrooms. The kitchen in the flat in the lower ground floor that is used by two people who have more independence remains unchanged and although has been well maintained is still in need of refurbishment. The home has a dog that is cared for by one of the service users. The external steps to front door are in need of repair as there are cracks in the concrete and could pose a risk to individuals. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 & 36 The training needs of staff are well met and appropriate training related to individuals needs is offered in order to support service users effectively. Staff receive regular supervision which helps staff to support individuals consistently. EVIDENCE: There are seven staff employed at the home, two of whom are newly appointed since the last inspection. Five staff have a National Vocational Qualification in Level 3, whilst the two remaining staff are in the process of being enrolled for a qualification in level 2. There is no change in that this meets with recommended minimum standards and clearly the home is committed to ensuring that the staff team are well trained in this respect. The home has a staff training and development policy and has continued in following procedures in identifying staff training needs, delivery and review of training. This was also evidenced through discussion with staff who related attendance at an Intensive Interaction course. It was also evident that this The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 20 training was beneficial in terms of meeting an individual’s communication needs. Staff indicated that they are supervised 4 – 6 weekly by the manager. They said the manager was approachable and supportive and training needs were supported well. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 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 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) 41 & 42 The home needs to improve in the reporting of incidents in order to protect individuals from possible risk of harm. There are procedures and protocols in place in order to ensure the health, safety and welfare of both service users and staff. EVIDENCE: The manager is supervised bi monthly by director of the home. She said she was happy with the arrangements in place and is supported through this system. It was evident through observation of documentation that the home carries out appropriate monitoring of all aspects of health and safety. This was evidenced through records relating to the maintenance of fire equipment, fire drills and The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 22 fire training. There were also records of water, refrigerator and freezer temperatures, and accidents. It was evident that there have been some occasions when incidents have occurred that were in need of being reported to the Commission under Regulation 37 notifications. These include both occasions when a service user has fallen and another has displayed behaviour that challenges. A requirement has been met to ensure that all cleaning products have a specific chemical data sheet. A Gas Safety check was carried out recently; the electrical circuit testing is due November 2005. The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x x x 4 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Avenue Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x 2 3 x D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 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 23 Regulation 12(1) Requirement Review current procedures in dealing with incidents of challenging behaviour in order to ensure the protection of all individuals from possible harm. Repair external steps leading to front door Inform the Commission of all incidents relating to falls and behaviour that challenges. Timescale for action 31/1/06 2. 3. 24 41 23(2)(b) 37 28/2/06 18/11/05 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 NONE Good Practice Recommendations The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG 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 The Avenue D56 D05 S8167 The Avenue 238625 Stage4.doc Version 1.30 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. 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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