Inspection on 30/06/08 for Westwood Avenue, 20

This inspection was carried out on 30th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westwood Avenue, 20 09/08/07

Westwood Avenue, 20 21/04/06

Westwood Avenue, 20 21/09/05

Westwood Avenue, 20 27/04/05

Westwood Avenue, 20 30/11/04

Westwood Avenue, 20 15/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Westwood Avenue, 20 South Harrow Middlesex HA2 8NS Lead Inspector Tony Lawrence Key Unannounced Inspection 30th June 2008 09:00 Westwood Avenue, 20 DS0000017580.V364410.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 Westwood Avenue, 20 DS0000017580.V364410.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. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westwood Avenue, 20 Address South Harrow Middlesex HA2 8NS 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) 020 8422 4176 020 8422 4176 monpeksoncare@aol.com Monpekson Care Limited Jean Page-Defour Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 9th August 2007 Date of last inspection Brief Description of the Service: 20 Westwood Avenue is a registered care home providing care and accommodation for 3 people with learning disabilities. When we visited, three men were living in the home and there were no vacancies. The home is owned by Monpekson Care Limited and was opened in 2000. The home is located in South Harrow and is a three bedroom semi-detached house, in a quiet residential street. The home is located within a few minutes walk from a variety of shops, pubs, cafes, post office, local bus and train services and other amenities and facilities. All the bedrooms are single. One bedroom is on the ground floor, and two bedrooms are located on the first floor. There are bathing and toilet facilities on both the ground and first floor. There is accessible street parking and limited off street parking. The home has an enclosed, accessible garden. Details of the fees charged for the service may be obtained, on request, from the provider. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection took place on Monday 30th June 2008 from 09:00 – 16:30. Tony Lawrence, Regulation Inspector carried out the inspection. We spent time talking with all three people who live in the home, staff who work with them and the home’s owner and manager. We ‘tracked’ the care of two people living in the home by talking with them and staff and checking care records kept in the home. During this visit we saw all communal parts of the home and the three residents’ bedrooms, with their permission. The home’s Manager completed and returned the Annual Quality Assurance Assessment (AQAA) we sent to her. The AQAA contained useful information about the service that we have used to write this report. Two relatives / carers or advocates also sent us confidential surveys and we have included their comments in this report. We would like to thank the people who live in the home, the staff, owner and manager for their time and help with our visit. What the service does well: What has improved since the last inspection? What they could do better: The Manager must make sure that she tells us about incidents involving people living in the home. The Manager and staff must also make sure that they follow the local authority’s safeguarding procedures when there are incidents involving people living in the home. The fire safety systems in the home must Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 6 be reviewed to make sure that residents, staff and other people are safe. The use of residents’ personal money to pay for items that should be provided by the home must be reviewed. 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 summary of this inspection report can be made available in other formats on request. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 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 Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a statement of purpose that is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a service user’s guide. All residents are given a copy of the guide. When requested the service can provide a copy of the statement of purpose and guide in a format which will meet the capacity of the resident. EVIDENCE: ‘I knew about this place and chose to come here’. (Comment from a resident). ‘I visited with my social worker before I came to live here’. (Comment from a resident). ‘We have revised and updated the Service User Guide into picture format, making it user friendly for those who have communication differences and abilities’. (Extract from the provider’s Annual Quality Assurance Assessment – AQAA). Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 9 During this visit we saw that the home had clear policies and procedures for the admission of new residents. It was not possible to assess how these procedures worked in practice as the three men living in the home have lived together since 2001 and there have been no recent admissions. We saw that the home’s Statement of Purpose and Service User Guide had been revised recently, providing clear information about the services provided for people who may want to live in the home. The Service User Guide had been produced using pictures and included information about how people’s religious and cultural needs would be met in the home. We also saw that staff from the home had completed a care needs assessment for each of the two residents whose care we tracked during this visit. This was done as part of the home’s admission procedures. The assessments gave a good overview of each person’s abilities and areas where they needed support. We saw that staff from the home regularly reviewed the assessments. The last reviews took place in February 2008. Two residents who spoke to us during our visit told us that they had visited the home and had made a positive choice to move into the home. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents know they will be involved in the planning of care which affects their lifestyle and quality of life. Staff understand the importance of residents being supported to take control of their own lives. People are encouraged to make their own decisions and choices. Care plans are person centred and are agreed with the individual. Plans are written in plain language, are easy to understand and look at all areas of the person’s life. They include reference to equality and diversity and address any needs identified in a person centred way. EVIDENCE: ‘I talk to my key worker about my care plan and we agree things’. (Comment from a resident). ‘I decide what I want to do and I tell the staff every day’. (Comment from a resident). Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 11 ‘Sometimes I go out by myself and sometimes staff go with me’. (Comment from a resident). ‘We regularly look at possible risks for each resident and agree how they can be minimised’. (Comment from a member of staff). ‘Each service user has key workers who have a clear working policy and procedures as to the role of the key worker and what is expected of them in providing active support to the key client’. (Extract from the provider’s Annual Quality Assurance Assessment – AQAA). During this visit we saw that each of the three people living in the home had a care plan that had been regularly reviewed. The care plans were very person centred, using photographs and plain English to make the information easier for residents to understand. The plans included good evidence that residents were involved in developing their own care plans, whenever possible. The plans covered individual’s personal and healthcare needs, including mental and physical health, activities, communication and contact with family and friends. Two residents who spoke to us knew about their care plans and both people told us they had been involved in writing their own plan. We saw that one resident had limited expressive verbal communication. During this visit we saw that all staff understood this person’s routines and the ways they communicated their needs. Staff worked well with this person to enable them to make choices about activities during the day. Staff who spoke to us understood the home’s risk management policy and procedures and the importance of assessing and minimising potential risks to residents. We saw that the two care plan files we reviewed during this visit included risk assessments that were regularly reviewed. Risk assessments covered road safety, mobility, finances, nutrition and behavioural issues. We also saw that each person’s care plan included a risk assessment that had been completed before residents went on holiday. All of the assessments were well written and included clear guidance for staff on how identified risks should be managed. Risk assessments also made sure that residents were supported to be as independent as possible, while also ensuring that people were safe. Staff told us that in response to a risk assessment about one resident’s challenging behaviours, a system of 1:1 counselling had been set up to enable the resident to talk about issues that may cause them anxiety. We saw that staff met with the person for a period each day to give them an opportunity for 1:1 support. Each session was well recorded by staff and the resident also told us that he found these sessions helpful. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. People who use the service have the opportunity to develop and maintain important personal and family relationships, and are able to access information and specialist guidance about issues such as intimate relationships. EVIDENCE: ‘I like the food, sometimes I help staff with shopping and cooking’. (Comment from a resident). ‘I can see my family when I want to and sometimes I stay with them’. (Comment from a resident). Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 13 ‘I’ve been to most places in Europe. We went to Denmark. It was good, but expensive’. (Comment from a resident). ‘My (relative) goes out on daily trips and has been on several holidays. Staff give firm advice and guidance to my (relative), with dedication and great care’. (Comment from a relative’s survey). ‘Central to the aims and objectives of the home is to promote the rights of each of the services users and their rights to live an ordinary and meaningful life, both in the home and out in the community’. (Extract from the provider’s Annual Quality Assurance Assessment – AQAA). During this visit we reviewed the care and support of all three people living in the home for the month of June 2008. We talked to two people about how they spent their time and also talked to staff about these two people and the third resident. We also checked what residents and staff told us against daily care records and each person’s care plan. Both residents told us that they went out almost every day. One person said that he talked to staff about what he would like to do each day and agreed what support he needed. The support varied according to the chosen activity. Some days, this person said that he went out alone to shops in Harrow or Watford. For longer trips, this person told us that staff were always available to go out with them. The daily care notes for all three people for June 2008 had been well completed by staff on duty each day. The notes showed that all three people went out almost every day, either independently or alone. People went for drives to Harrow, local walks and lunch out, trips to local cafes, shops and social clubs. Activities in the home included head massage and art therapy sessions. We also saw that residents’ bedrooms were very individual and pleasant places to spend time. People had TV’s and music systems in their rooms and two people said that they often spent time watching TV, reading or listening to music. Two residents told us that they had been to Denmark earlier this year. Both people said that they had enjoyed the holiday. Staff told us that the third resident had been on holiday in the UK. We saw that care plans included information about individual’s families, friends and other significant people. Plans also included the contact details and arrangements for these people. Daily care notes showed us that staff regularly supported residents to keep in touch with relatives and friends. Care plans also considered residents’ sexuality and how these needs would be met in the home. For one person, accessible information had been provided to help them to understand the need for privacy during sexual activity. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 14 We felt that residents’ care plans, the home’s Statement of Purpose and Service Users’ Guide clearly explained people’s rights and responsibilities. Two residents told us that there were some house rules and they were able to tell us what these were and why they were important. Two residents told us that they chose what they wanted to eat each day. They said that there was always a choice and they enjoyed the food that was provided. Staff said that the menu was written up after each meal to record what each resident had eaten. We saw that the menu showed a good variety of nutritious meals was provided for residents each day. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents know they will receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. People know their healthcare needs, including specialist health, nursing and dietary requirements are clearly recorded in each person centred plan or health action plan. EVIDENCE: ‘Each of the service users is given support, supervision and assistance with their personal and health care. The principles of care are promoted by all members of staff who are trained to ensure that each service user, based on their individuality, is treated with dignity, diversity, respect and privacy’. (Extract from the provider’s Annual Quality Assurance Assessment – AQAA). During this visit we saw that residents’ care plans included clear information about their daily routines and preferences regarding support with their personal care needs. The times that people get up in the morning and go to bed at night, whether they prefer a bath or shower in the morning or in the evening and other information was clearly recorded and regularly reviewed. As Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 16 with other areas of care in the home, we saw an emphasis on maintaining residents’ independence as much as possible with regards to their personal care. Daily care notes that we checked also included clear information about individual’s personal care. We would recommend that staff stop using the ‘bath book’ to record when residents have a bath each day. We felt this was an institutional practise and the information is also duplicated in the daily care notes. We also saw that residents’ healthcare needs were well recorded in their care plans and in Health Action Plans. Both plans included a good overview of each person’s healthcare needs and how these would be met by staff in the home, primary or specialist health services. We saw that the care plans and Health Action Plans for all three people living in the home included evidence of appropriate links with health care professionals, including mental health services, the local multi-disciplinary Learning Disability Team, GP’s, Community Nurses, opticians, dentists and chiropodists. During this visit we checked the home’s arrangements for managing residents’ prescribed medication. The home used a monitored dosage system provided by a local pharmacist. The pharmacist delivered each person’s medication in dosette boxes every month. The home provided secure storage in a lockable cupboard and the home’s Manager completed a medication audit in January 2008. We checked the Medication Administration Record (MAR) sheets for two people living in the home. We saw that these records were well completed by staff each day. To make sure that staff have the latest guidance on the management of prescribed medication, it is a recommendation of this report that the Manager obtains a copy of the latest guidance from the Royal Pharmaceutical Society. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People living in the home experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is provided in formats that are accessible to people living in the home. Links with external agencies are adequate, but there is a lack of understanding of safeguarding procedures and how they work. There may be an ‘it could not happen here’ mentality within the service and referrals may not be made because of this or just through a lack of understanding. The outcomes from any referral are adequately managed, with the issues resolved but not learnt from. EVIDENCE: ‘I’d talk to the staff if I was worried about anything’. (Comment from a resident). ‘If I wanted to complain, I’d talk to the manager’. (Comment from a resident). ‘The home has an open door policy in regard to complaints, protection, concerns and compliments. The complaints procedure is on open display at the entrance of the home and each service user has been provided with a picture format of how to complain. All staff have had POVA training on a yearly basis’. (Extract from the provider’s Annual Quality Assurance Assessment – AQAA). During this visit we saw that the home has a clear complaints procedure that had been produced using pictures to make the information easier for residents to understand. We saw that the procedure was displayed on a notice board by Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 18 the front door and in other places around the home. While residents told us that they would speak to staff or the home’s Manager if they had any concerns, the Manager said that there had been no formal complaints recorded since our last visit in August 2007. When speaking with two people who live in the home, we felt that there were issues that, although they appeared to have been well managed, could have been recorded as complaints. This would provide evidence about the home’s response when issues were raised. The Manager and staff team must discuss the home’s policy to make sure that issues raised by residents and other people are consistently recorded. Following a requirement made after our last inspection in August 2007, the Manager had obtained a copy of the local authority’s safeguarding adults policy and procedures. Staff who spoke with us knew that the procedures were available for reference. Staff also said that they had completed training in the protection of vulnerable adults. While we felt that the Manager and staff had a good theoretical knowledge and awareness of the importance of safeguarding adults, we could find little evidence that this is translated into daily practise. For example, one resident told us about a recent incident that happened while he was in the local community. The person was not with staff at the time of the incident. While we felt the person managed the situation well and told staff when he returned to the home, we felt that this should have been referred to the local authority under the safeguarding procedures. This would have enabled all of the people involved in the resident’s care to discuss the possible risks and agree strategies to minimise these, without restricting the person’s independence. In an incident in May 2008, all three residents were out with two members of staff. One resident became anxious and twice ran into the road, hitting himself and throwing a drink at one of the staff. Again, while we felt the staff managed the situation well, this incident should have been referred to the local authority, as they are the lead agency responsible for safeguarding adults. In a third incident in June 2008, a resident threatened a member of staff in the home. Again, this incident should have been reported to the local authority to enable all those involved in the person’s care to agree how similar incidents should be managed. The Manager must also make sure that she tells us about incidents involving people living in the home, so that we can be confident residents are cared for safely. We should have been told about all three of the incidents mentioned above. This is a requirement of the Care Homes Regulations 2001. The Manager and staff must also make sure that they follow the local authority’s safeguarding procedures when there are incidents involving people living in the home. Incidents should be reported to the local authority, as they are the lead agency. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 19 During this visit we checked the personal finance records of all three people living in the home. We saw that the records were well completed by staff and receipts were kept for any expenditure involving people’s personal money. We did note that one resident was paying for toilet paper. We discussed this with the Manager who explained that the decision had been made as the person used lots of toilet paper and kitchen towels. We felt that this use of the resident’s personal money was inappropriate and must be reviewed, to make sure that individual’s money was not used to pay for items that should be covered by the home’s weekly fees. If extra expenditure is needed because of a person’s behavioural issues, this must be discussed with the local authority responsible for funding the placement as part of the person’s care management and agreement reached about responsibility for payment. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. Residents are encouraged to personalise their bedrooms. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The environment promotes the privacy, dignity and autonomy of residents. EVIDENCE: ‘I like my room, I’ve got everything I need, my TV and books’. (Comment from a resident). ‘The home is person-centred to each individual who lives in the home. They have the freedom to personalise their rooms and make choices in the colour scheme. It is decorated according to the choice of each service user and yearly the decorating is reviewed’. (Extract from the provider’s Annual Quality Assurance Assessment – AQAA). Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 21 20 Westwood Avenue is a 3-bedroom semi-detached house in a quiet residential street in South Harrow. It is indistinguishable from neighbouring properties and is suitable for use as a care home. The home is located within a few minutes walk from a variety of shops, pubs, cafes, post office, local bus and train services and other amenities and facilities. There are 3 single bedrooms, one on the ground floor and two on the first floor. The staff office / sleep in room is also on the first floor. There is a shower room and toilet on the ground floor and a bathroom and toilet on the first floor. The lounge, kitchen / dining room and utility room are on the ground floor. There is unrestricted street parking outside the home. The home has an enclosed, accessible garden. When we visited, all parts of the home were clean and hygienic. During this visit we saw all communal parts of the home and the three bedrooms. The home was well decorated and comfortably furnished. Residents’ bedrooms were spacious and comfortable; they reflected residents’ interests and hobbies and had been personalised with the individual’s own furniture, pictures and other possessions. The communal areas were also well decorated, comfortable and well furnished. The kitchen was well equipped. The bathroom and toilets were satisfactory, although a lock must be provided for the first floor toilet door to make sure residents can use this facility in private. We also discussed the home’s fire safety arrangements with the Manager and staff on duty during our visit. The Manager told us that the home was originally registered as a ‘small care home’ and the fire safety requirements were not as stringent as those for a larger home. We saw that the fire door leading to the kitchen was propped open and this presented a significant risk in the event of a fire, as smoke and flames would not be confined to the kitchen area, allowing people to evacuate the building. The walls of the kitchen were covered in wood panels that would provide fuel in a fire. There was no heat or smoke detector in the kitchen and no hard-wired fire alarm system installed in the home. To make sure that people living and working in the home are safe, the home’s fire safety arrangements must be reviewed and agreed with the fire authority. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home told us they have confidence in the staff who care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. All staff receive relevant training that is focussed on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. EVIDENCE: ‘I like all the staff, they help me do things I want to do’. (Comment from a resident). ‘I talk to staff every day about how I’m feeling. They listen to me and help me’. (Comment from a resident). ‘I think it is a lovely care home with caring and dedicated staff’. (Comment from a relative / carer’s survey). Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 23 ‘All staff receive training; all mandatory training is undergone by all members of the team. The staff team has achieved NVQ Level 2 or above. Currently the majority of staff are on a course with Asset (Aylesbury College) for infection control, safe handling of medication and health and safety in the workplace’. (Extract from the provider’s Annual Quality Assurance Assessment – AQAA). During this visit we spoke to two staff who were on duty and the home’s Manager. We also spoke with the home’s owner who was there for part of the day. We felt that staff had the experience and qualifications needed to provide good standards of care for people living in the home. During this visit we saw that all of the staff, the Manager and owner worked well together to make sure that each resident was supported appropriately. All those who worked in the home knew each resident and their care needs very well and people’s requests for support were responded to appropriately and consistently. The Manager and staff told us that all of the care staff working in the home had completed their National Vocational Qualification (NVQ) training to Level 2 or 3. During this visit we checked the staff personnel files for the Manager and two care staff working in the home and saw that all three people had completed a detailed induction training programme. The two care staff had received regular supervision and an annual appraisal, although the Manager should make sure that appraisals include a detailed record of issues discussed and goals and actions agreed. We saw that the staff personnel files we checked also included copies of people’s passports, an application form, 2 written references, an employment contract, copies of training certificates and a Criminal Records Bureau (CRB) check. This was evidence that staff working in the home are suitable people to work with vulnerable adults. Two relatives / carers who sent us confidential surveys said that the home gave resident the support they expected. Both people also told us that the care staff working in the home ‘always’ or ‘usually’ had the right skills and experience to look after people properly. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42. People living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. She has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. She works to continuously improve services and provide an increased quality of life for residents, with a strong focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. EVIDENCE: ‘The management of the home is carried out in a manner that is open and offers respect to staff, service users and all those who are involved with the service users. The managers who are responsible for running of the day-today service are qualified to NVQ levels 4 and 5 and have been in the social care field for over twenty-eight years. The proprietors are both registered Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 25 nurses and still hold their registration with the NMC. They too have been working in health services for over twenty-eight years’. (Extract from the provider’s Annual Quality Assurance Assessment – AQAA). The home’s Manager told us that she had completed the NVQ Registered Manager’s Award. She is also a NVQ Assessor and has worked in social care with children and adults for more than 20 years. We have registered the Manager as a ‘fit person’ to manage a care home. During this visit we felt that the Manager demonstrated a very good knowledge of recent and planned developments in social care and best practice in the field of learning disability. The Manager returned the Annual Quality Assurance Assessment (AQAA) that we sent to her as part of this inspection. The AQAA was detailed and well completed and gave us valuable information that we have used to write this report. The Manager told us in the AQAA that the provider planned to ‘develop a new and more effective quality system that can be adapted into picture format, which can be used and can be effective and productive to the consistent improvement of the service that the home offers’. Two residents told us during this visit that staff asked them for their ideas about ways to improve the services they received. One person mentioned regular monthly meetings with staff to discuss the running of the home. During this visit we checked a variety of care records kept by staff in the home, including residents’ care plans, risk assessments, daily care notes, accident and incident reports and residents’ finance and medication records. We felt that standards of record keeping in the home were good. We saw that the provider had completed a fire safety risk assessment in July 2007. Staff kept a good record of monthly fire drills, fire equipment was serviced in May 2008 and portable electrical equipment safety checks were completed in October 2007. As noted earlier in this report, the fire safety systems in the home must be reviewed and agreed with the fire authority to make sure that residents, staff and other people are safe. Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 26 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 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 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 3 3 3 X 3 2 X Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 27 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 YA22 Regulation 22 (3) Requirement To show that residents’ complaints are dealt with appropriately, the Manager and staff team must discuss the home’s policy to make sure that issues raised by residents and other people are consistently recorded. The Manager must make sure that she tells us about incidents involving people living in the home, so that we can be confident residents are cared for safely. To show that residents are cared for safely, the Manager and staff must make sure that they follow the local authority’s safeguarding procedures when there are incidents involving people living in the home. To make sure that individual’s money is not used to pay for items that should be covered by the home’s weekly fees, the Manager must review the practise of one resident paying for toilet paper. To make sure that people living and working in the home are DS0000017580.V364410.R01.S.doc Timescale for action 30/09/08 2. YA23 37 30/09/08 3. YA23 13 (6) 30/09/08 4. YA23 13 (6) 30/09/08 5. YA24 23 30/09/08 Westwood Avenue, 20 Version 5.2 Page 28 6. YA27 23 (2) c safe, the home’s fire safety arrangements must be agreed with the fire authority. A lock must be provided for the first floor toilet door to make sure residents can use this facility in private. 30/09/08 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 YA18 Good Practice Recommendations Staff should stop using the ‘bath book’ to record when residents have a bath each day. We felt this was an institutional practise and the information is also duplicated in the daily care notes. To make sure that staff have the latest guidance on the management of prescribed medication, the Manager should obtain a copy of the latest guidance from the Royal Pharmaceutical Society. To show that staff are supported appropriately, the Manager should make sure that annual appraisals include a detailed record of issues discussed and goals and actions agreed. 2. YA20 3. YA36 Westwood Avenue, 20 DS0000017580.V364410.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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