Care Home: 89 Grosvenor Avenue

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What the care home does well Grosvenor Avenue provides a homely environment for the people who live there. People told us they are ‘happy here’, ‘have all I need’ and ‘I do the things I like’. Staff told us they are supported to do their job and have plenty of training to develop their skills. Good information is available about the services provided. Assessments are completed and kept up to date. Care plans are in place and reviewed monthly and annually. People have access to some regular activities and outings. People’s health needs are well recorded and met. Medication is well managed. Staff have good training opportunities. What has improved since the last inspection? The manager and staff have worked hard to improve the services provided, with a big emphasis on staff training and providing more opportunities for the people who use the service. Risk assessments are completed. Kept under review and updated as required, ensuring people are protected from unnecessary harm. Clear details are kept of any health appointments and any actions for staff to take. This ensures people’s health needs are met. All new staff complete induction training and are in the process of NVQ training. The staff rota was up to date with the staff on duty during our visits. Staff recruitment records were seen to contain two written references and 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 confirmation that a Criminal Records Bureau check had been completed before they started work. This ensures that the people who use the service are protected. The manager sent a notification to the Commission when a person who uses the service needed emergency medical treatment. The Service Users Guide has been developed in a more accessible format, making it easier to understand. Care plans have been developed to include the care and support individuals need. Annual reviews of care have taken place. These issues were raised at the last inspection and the manager has shown a commitment to improving the services provided and has plans to develop the service further. A number of bedrooms have been redecorated, bringing the environment to a good standard for the people who live there. What the care home could do better: More work could be done to make care plans more detailed and include more information to help staff provide the best support to individuals. There could be more opportunities for people who use the service to access the community and have more meaningful ways to fulfil their leisure and occupation needs. Staff should have more regular supervision for support and monitoring, to ensure they are providing good quality care. The manager should register with the CQC at this point, rather than wait, to continue with consistency of management and emphasis on improving the services provided. Key inspection report CARE HOME ADULTS 18-65 89 Grosvenor Avenue Carshalton Surrey SM5 3EN Lead Inspector Emma Dove Key Unannounced Inspection 16th July 2009 17:00 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 89 Grosvenor Avenue Address Carshalton Surrey SM5 3EN 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 8647 3912 020 8647 3912 manager.grosvenoravenue@careuk.com Care Solutions Limited Manager post vacant Care Home 5 Category(ies) of Learning disability (0) registration, with number of places 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (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 (LD). The maximum number of service users to be accommodated is 5. Date of last inspection 22nd July 2008 Brief Description of the Service: 89 Grosvenor Avenue provides residential care for up to five people with learning disabilities. Five people are currently living there. The home is located in a residential road in Carshalton, close to local shops and amenities with good transport links. The home is not identifiable as a care home and is in keeping with neighbouring houses. Information about the service is available in the Statement of Purpose and Service User Guide. The fees vary depending on peoples assessed need. 89 Grosvenor Avenue DS0000007134.V377182.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 2 star. This means people who use the service experience good quality outcomes. This unannounced inspection took place over one hour on the 16th, three hours on the 21st and two hours on the 24th July 2009. One regulation inspector visited, spoke with people who use the service, staff and the manager. Surveys were sent to placing social workers and other stakeholders, although we have not received any completed surveys. We received a completed annual quality assurance assessment (AQAA), which contained information about what the service does well and areas that will be developed over the next year. We also looked at information received from the service since the last inspection in July 2008. What the service does well: What has improved since the last inspection? The manager and staff have worked hard to improve the services provided, with a big emphasis on staff training and providing more opportunities for the people who use the service. Risk assessments are completed. Kept under review and updated as required, ensuring people are protected from unnecessary harm. Clear details are kept of any health appointments and any actions for staff to take. This ensures people’s health needs are met. All new staff complete induction training and are in the process of NVQ training. The staff rota was up to date with the staff on duty during our visits. Staff recruitment records were seen to contain two written references and 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 6 confirmation that a Criminal Records Bureau check had been completed before they started work. This ensures that the people who use the service are protected. The manager sent a notification to the Commission when a person who uses the service needed emergency medical treatment. The Service Users Guide has been developed in a more accessible format, making it easier to understand. Care plans have been developed to include the care and support individuals need. Annual reviews of care have taken place. These issues were raised at the last inspection and the manager has shown a commitment to improving the services provided and has plans to develop the service further. A number of bedrooms have been redecorated, bringing the environment to a good standard for the people who live there. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 89 Grosvenor Avenue DS0000007134.V377182.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 89 Grosvenor Avenue DS0000007134.V377182.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. Admissions are only made after an assessment of needs has been completed, to ensure the service is appropriate for the individual. EVIDENCE: The service has developed a pictorial Statement of Purpose which includes details of the organisation, the manager, staff, the services provided, that it is registered with the Commission and details of annual reviews. This information will help prospective people decide if the service is right for them. We saw assessments of needs in case files. These documents are kept under review and updated as required. There have been no new admissions since the last inspection, but the manager is aware of the process to be followed and said they would invite prospective people to visit and meet people who live there and staff as a part of the assessment process. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are involved in planning their care, developing and reviewing care plans and making decisions that affect their future. Risk assessments are in place. EVIDENCE: We saw care plans have been developed to include the care, support and assistance individuals need and their preferences. These are reviewed monthly. These documents have improved since the last inspection but could still include more detail of the care and support individuals need and their preferences for receiving support. The manager showed us the new person centred plans which are being developed with the people who use the service, these include goals the individual wants to achieve. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 10 We discussed life story work and developing photograph books and albums of memories for individuals. The manager said he will discuss this with people and see if it would be useful. We saw one file contain a communication dictionary, which is a list of the words and gestures used and what they mean. This is a good resource and should be maintained to ensure staff have information to be able to communicate with the person. We saw case files contain details of individual’s religion and any specific needs they may have to maintain their faith. The manager told us they have annual reviews of the care and support provided when the people who use the service, their relatives or representatives and placing social workers are invited to discuss the past year and make plans for the future. We saw records of annual reviews. We saw risk assessments in place, which are kept under review. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager told us that they listen to people who use the service and support them to make decisions about what they want to do and the food they eat. EVIDENCE: People told us they do what they want, saying they go to day centres, clubs and out to the shops. We saw people return from day centres and sessions, be out shopping, waiting to see relatives, talking with staff, listening to music, spending quiet time in their room and spending time in the garden during our visits. The manager said they have an aromatherapist visit every week who sees each person individually. The manager told us one person who uses the service represents the home at the monthly ‘Speak Out’ group. A group run by the organisation for people 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 12 form their homes in the area, to look at developing the service, discuss topical issues and plan future events. The manager told us they have booked holidays for people who use the service. One person told us they were due to go on holiday. The holiday is paid for by the organisation as a part of the weekly fee. We saw people sit down and enjoy an evening meal and lunch during our visits. Staff told us they cook meals and encourage people to be involved in meal preparation, laying the table and clearing away. People told us they ‘like the food’ and said ‘dinner was good’ and ‘the food is usually good’. People told us they choose what they eat. We saw records are kept of the food individuals eat. The manager told us most of the food is home cooked from fresh produce, which is an improvement since the last inspection. The manager said that any health and religious dietary needs can be met. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health care professionals and their health care needs are well met. Medication is well managed EVIDENCE: We saw detailed records of health appointments, including changes to medication and any actions staff need to take. We saw health action plans which detail the medication individuals take and what it is for. Medication is appropriately stored, labelled and had been administered as per instructions. Medication records were up to date and signed by staff. Systems are in place to check medication has been administered every week. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a clear complaints procedure which is accessible to the people who use the service. Appropriate policies are in place for safeguarding and staff have completed training. EVIDENCE: The manager told us they work with people who use the service to understand the process of making a complaint. People who use the service told us they have nothing to complain about. The manager told us they have not received any complaints since the last inspection. We have not received any complaints or concerns in the last year. We saw letters of compliment and thanks to the manager and staff from relatives regarding support or care received. The manager told us all staff complete training in the protection of vulnerable adults and are aware of the policy and the actions they should take. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the needs of the people who live there. The environment is well maintained. Bedrooms are single. All areas are well lit, clean and tidy. EVIDENCE: The manager told us they have redecorated a number of bedrooms and worked to improve the environment to make it good for the people who live there, to improve their self esteem. They have plans to buy furniture for the lounge and other areas of the home and will be having communal areas redecorated. People told us they have all they need in their rooms and we saw people relaxed in the lounge. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 16 People have access to a lounge and kitchen/dining room on the ground floor with access to the garden. Bedrooms are single and we saw they have been redecorated and personalised to the individuals taste. One person confirmed they chose the colour their bedroom was painted. People told us they are ‘happy with my room’ and said ‘I like my room’. There are enough bathrooms and toilets for the people who use the service. All areas of the home were clean and fresh. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are sufficient to meet people’s needs. Staff recruitment is in line with regulations, to keep people who use the service safe. Staff have good training opportunities and have some supervision. EVIDENCE: We saw enough staff to meet the needs of the people who use the service. Three members of staff work during the day and one member of staff is awake and one asleep but on call at the home at night. The manager is available in addition to these staff on weekdays. The staff rota was up to date and reflected the staff on duty during our visits. Staff told us there are enough staff to enable people who use the service to go out and do the things they want to do. The manager told us they seek references and a Criminal Records Bureau (CRB) check before new staff start work at the home. We saw records 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 18 confirming that references and CRB checks were completed before staff started work. The manager said they plan to involve people who use the service in staff recruitment. The manager told us staff have completed training in autism, epilepsy, the Deprivation of Liberties Safeguarding, safeguarding and the core induction standards. We saw records confirming staff have completed training in the last year. We saw that staff are in the process of completing NVQ to level 2 and 3. The manager told us he sees staff for supervision. Staff told us the manager is always available for information, advice and support. Records showed some staff have not been receiving supervision at the required intervals. This was discussed with the manager who said he will increase the number of supervision sessions staff have. We saw staff meeting minutes, which take place every month. These meetings give staff the opportunity to update the team on any changes for the people who use the service, plan for future events and look at current issues. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the knowledge and experience to run the home. The service is well run in the interests of the people who live there. The annual quality assurance assessment included information about what the service does well and areas they plan to improve. Health and safety is well managed with records up to date. EVIDENCE: The manager has been at the home for over a year and has previous experience in a similar service. The manager told us he is waiting until he has completed NVQ to level 4 before he registers with the Commission. This is not necessary and he can apply to register at this point. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 20 Quality assurance systems are in place to ensure people who use the service and their representatives have opportunities to comment about the care and support provided. The manager told us he is due to send out annual surveys to people and will use the information from these to develop the service if required. A representative from the organisation visits every month and speaks with people who live there, staff and looks at records as a part of the quality assurance process. We saw copies of the reports from these visits which indicate an improvement in the services provided over the past year. The organisation has developed a new audit tool which the manager will complete. The manager told us health and safety checks have been completed at the appropriate times. We saw records confirming that the gas safety and electrical supply were tested in August 2008 and September 2006. The fire alarm is tested weekly with monthly fire drills. People who use the service and staff told us they are aware of how to respond to the fire alarm. 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 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 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X Version 5.2 Page 22 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations More work could be done to make care plans more detailed, to give staff more guidance when supporting people. People who use the service could access more community activities to meet their social and leisure needs. The manager should apply to register with the Commission. 2. 3. YA13 YA37 89 Grosvenor Avenue DS0000007134.V377182.R01.S.doc Version 5.2 Page 23 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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