Care Home: Avenue Road

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What the care home does well People who live at Avenue Road, their relatives and staff all express high levels of satisfaction about the service they receive. Their experiences of care are very positive. Care plans are written well and tell staff in detail how each individual likes and needs to be supported. People who are able can travel and access the community independently. Those who need two staff to support them to access the community safely, receive this. Individual staff and the staff team as a whole is effective. Staff are pleasant, motivated, very well trained and as such are confident and competent. Staff feel very well supported and are happy in their work. There is a very low turnover of staff. There are no staff vacancies and has been no new staff recruitment for two years. This is a considerable achievement and provides people who live there with continuity and consistency. A recent independent audit of infection control practice by representatives from the National Health Service assessed the service as 94.1% effective. The service is well managed and people who live there benefit from this. We were told ` The staff and Sarah are doing a good job because they give me a choice of what activity I want to go on and some staff come with us on day trips and to the sea side`. A relative explained how she would rate the home as `very very good`. She described why. `They are quickly on to medical care and are managing behaviours very well. I am made very welcome and am provided with a sandwich and a cup of tea. The place is always kept lovely and X is always neat and tidy and looks lovely. I am very satisfied and pleased with the staff. I like them all. They are great. I just wish they were paid more`. What has improved since the last inspection? There have been a number of improvements. Medication management systems have improved. Staff are clearly confident and competent administering medication and people are receiving their medication as it is prescribed. This supports their health and well-being. Some aspects of the environment have improved. Most noticeably are the provision of new bedroom carpets and a new suite to provide clean, cleanable and comfortable seating for people living there. The kitchen has been painted and drawers and cupboards replaced. This has improved what was previously unacceptable and is now providing an environment that people living there and staff can value. Although systems still need to improve to enable a service user to know how much money is held on his behalf, generally financial systems are safe and account well for service users expenditure especially where it is made on their behalf. The manager is fully aware of circumstances when service users should meet expenses and when the organisation should. Safety training is now better provided to staff and fire drills have been held regularly. What the care home could do better: Brochures and contracts available to new and existing residents still need to be reviewed and updated to ensure that information is current and residents are aware of their rights and responsibilities. It would benefit residents if this information was provided in accessible formats as several people told us they cannot read well. Care plans, which are written documents that tell staff how to provide individualised care, are written well. Best practice is to involve service users in their development and review. Discussion with service users indicated that they were unfamiliar with care plans. The Manager and staff did not agree, but service users involvement in their current plans could not be confirmed. Activities and social opportunities are provided but this could be better. Where opportunities are offered but declined, this should be recorded to better account for service quality and to help the service to monitor and review the opportunities it provides. This also applies to the provision of cultural meals. Service users are not being provided with a holiday each year although we are told there are plans to provide a holiday this year, 2008. Staffing levels are safe but improvements in line with a previous requirement would enhance opportunities for more individualised social programmes.Staff have all received training in the abuse and protection of vulnerable adults and discussion with them showed they have a very robust and faultless understanding of their responsibilities. It was disappointing then to find that a requirement to ensure the referral of an individual to the national Protection of Vulnerable Adults (POVA) list has not been met. This was in response to a matter that was dealt with by the Courts. Although service users at Avenue Road have been safeguarded, people living in the wider community may be at risk. The Manager undertook to raise this matter with her seniors and with Social Services without delay. Avenue Road is managed well on a day-to-day basis. Most management systems that we requested were readily available and are up to date. We agreed with the manager the need for her to review general risk assessments about the environment as these were last done in 2005. Chemicals are safely stored. However, there are not assessments in place to address the risk of hazardous chemicals stored on the premises. We informed the manager that data sheets for these products are not sufficient as she should be using the information within the data sheets to assess the risks and controls needed for each product. The Manager feels well supported by her team and senior managers. She is not receiving formal supervision however and her performance is not being appraised. She is confident in her role and does not feel disadvantaged by this. However, she is entitled to supervision and it is essential as a tool to ensure that management is proactive. The provision of structured, good quality supervision has the potential to further improve the performance of this good service. CARE HOME ADULTS 18-65 Avenue Road 35 Avenue Road Darlaston Walsall West Midlands WS10 8AR Lead Inspector Deborah Sharman Unannounced Inspection 7th March 2008 09:00 Avenue Road DS0000020834.V352711.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 Avenue Road DS0000020834.V352711.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. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avenue Road Address 35 Avenue Road Darlaston Walsall West Midlands WS10 8AR 0121 526 3313 0870 609 2435 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) Swan Village Care Services Limited Sarah Jane Ann Perry Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2006 Brief Description of the Service: Avenue Road is a detached two-storey premise that is connected to all main services. The home offers five single bedrooms (without en-suite facilities), a large lounge and separate dining room. There are bathing, shower and toilet facilities on each floor. Swan Village Care Services Limited which are now part of the Minster Pathways group own the home and others nationally. The home is situated in a quiet area of Darlaston and is close to all the local amenities such as shops, pubs, library, parks and public transport. The home is registered for the care of five adults with a learning disability. All of the present service users also demonstrate some challenging behaviours. Staff at the home uses a client-focused approach, with the aim being to encourage and develop maximum potential and independence for each service user. All packages incorporate choice, privacy, dignity and respect. The weekly fee has not been updated in the homes literature. Therefore enquiries about fees should be made directly to the Manager at Avenue Road or the provider. Avenue Road DS0000020834.V352711.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 stars. This means that the people who use this service experience good quality outcomes. One Inspector carried out this unannounced key inspection between 8:50 am and 5.50 pm. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The registered manager completed this document and returned it to us. Comments from the AQAA helped us to formulate a plan for the inspection. Additionally prior to inspection, we sought the views of people living at the home and those of their relatives and other independent professionals associated with the home. Written responses were received from one health professional. Two people who live at Avenue Road returned questionnaires that they had completed. We also received completed surveys from eight staff. We did not receive written feedback from relatives of people who live there. All this information was analysed prior to inspection and helped to formulate a plan for the inspection and has helped in determining a judgement about the quality of care the home provides. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. The homes registered manager, senior and other staff, supported the inspection day. A resident at the home showed us round and this gave us the opportunity to assess the accommodation. We observed lunchtime and we also observed medication being administered. We interviewed two staff members and talked separately in private to three of the five people living at the home about their experiences. We also looked in detail at care provided to two service users. Although we had not received any written feedback from Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 6 relatives who have contact with the service, we had the opportunity during the inspection to talk on the phone to one relative about her impression of the quality of care. We also had access to the results of relatives’ surveys instigated by the home in 2007. This told us what relatives and visitors think about the service that Avenue Road provides. We sampled a variety of other documentation related to the management of the care home such as training, maintenance of the premises, and complaints. We could not assess how staff are recruited because the records were not made available to us. However the manager and a senior staff member provided assurance that they have not appointed any new staff for two years and not since we carried out the last inspection. What the service does well: People who live at Avenue Road, their relatives and staff all express high levels of satisfaction about the service they receive. Their experiences of care are very positive. Care plans are written well and tell staff in detail how each individual likes and needs to be supported. People who are able can travel and access the community independently. Those who need two staff to support them to access the community safely, receive this. Individual staff and the staff team as a whole is effective. Staff are pleasant, motivated, very well trained and as such are confident and competent. Staff feel very well supported and are happy in their work. There is a very low turnover of staff. There are no staff vacancies and has been no new staff recruitment for two years. This is a considerable achievement and provides people who live there with continuity and consistency. A recent independent audit of infection control practice by representatives from the National Health Service assessed the service as 94.1 effective. The service is well managed and people who live there benefit from this. We were told ‘ The staff and Sarah are doing a good job because they give me a choice of what activity I want to go on and some staff come with us on day trips and to the sea side’. A relative explained how she would rate the home as ‘very very good’. She described why. ‘They are quickly on to medical care and are managing behaviours very well. I am made very welcome and am provided with a sandwich and a cup of tea. The place is always kept lovely and X is always neat and tidy and looks lovely. I am very satisfied and pleased with the staff. I like them all. They are great. I just wish they were paid more’. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Brochures and contracts available to new and existing residents still need to be reviewed and updated to ensure that information is current and residents are aware of their rights and responsibilities. It would benefit residents if this information was provided in accessible formats as several people told us they cannot read well. Care plans, which are written documents that tell staff how to provide individualised care, are written well. Best practice is to involve service users in their development and review. Discussion with service users indicated that they were unfamiliar with care plans. The Manager and staff did not agree, but service users involvement in their current plans could not be confirmed. Activities and social opportunities are provided but this could be better. Where opportunities are offered but declined, this should be recorded to better account for service quality and to help the service to monitor and review the opportunities it provides. This also applies to the provision of cultural meals. Service users are not being provided with a holiday each year although we are told there are plans to provide a holiday this year, 2008. Staffing levels are safe but improvements in line with a previous requirement would enhance opportunities for more individualised social programmes. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 8 Staff have all received training in the abuse and protection of vulnerable adults and discussion with them showed they have a very robust and faultless understanding of their responsibilities. It was disappointing then to find that a requirement to ensure the referral of an individual to the national Protection of Vulnerable Adults (POVA) list has not been met. This was in response to a matter that was dealt with by the Courts. Although service users at Avenue Road have been safeguarded, people living in the wider community may be at risk. The Manager undertook to raise this matter with her seniors and with Social Services without delay. Avenue Road is managed well on a day-to-day basis. Most management systems that we requested were readily available and are up to date. We agreed with the manager the need for her to review general risk assessments about the environment as these were last done in 2005. Chemicals are safely stored. However, there are not assessments in place to address the risk of hazardous chemicals stored on the premises. We informed the manager that data sheets for these products are not sufficient as she should be using the information within the data sheets to assess the risks and controls needed for each product. The Manager feels well supported by her team and senior managers. She is not receiving formal supervision however and her performance is not being appraised. She is confident in her role and does not feel disadvantaged by this. However, she is entitled to supervision and it is essential as a tool to ensure that management is proactive. The provision of structured, good quality supervision has the potential to further improve the performance of this good service. 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. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 9 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 Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 10 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, 5. Quality in this outcome area is adequate. Avenue Road has a settled group of residents. How new people experience admission to the home could not be assessed as there have been no admissions or discharges for three years. Future and current service users however do not have accurate information about their rights and responsibilities as written information about the service has not been updated with relevant information and is not in appropriately accessible formats. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home told us how they don’t read very well. The Manager is working on developing literature for them in pictorial formats and would like to develop audiovisual versions but these are not available to inform current and future residents of their rights and responsibilities. The Service User Guide is due to be reviewed. The Statement of Purpose was reviewed in December 2007 and includes fee levels although this has not been updated since a change in fee was introduced and fees are not referred to in the Service Users Guide. The Statement of Purpose describes how, in line with their registration they are able to admit people with learning disabilities. The primary needs of one service user however does not comply with the homes Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 11 stated purpose and registration. Although there are no evident concerns about how this persons needs are being met, the Manager has reported it to restrict support services that can be accessed on the person’s behalf. The Provider should review this and consider applying to us for a variation to the category of registration. A previous requirement to review service users contracts with the home has not been met. The Manager explained how on querying this, head office disagreed with the need to do so. Assessment of contracts again shows them to state that they will be reviewed in October 2007. This has not happened. It is positive that all parties including the service users and their representatives had signed them, but again consideration should be given to ensuring they are in easy read alternative formats. Although these omissions do not appear to have impacted upon people living there in any measurable way, lack of compliance with our requirements issued in 2006 has reduced the overall outcome from good to adequate for this group of Standards. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 12 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, 9. Quality in this outcome area is good. Care planning and risk assessments ensure that service users needs are known and acted upon with risks identified and minimised appropriately. The system for service user consultation remains good and there is some evidence that service users views are sought and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the annual return sent to us the manager told us that ‘‘All service users have a detailed support plan which are personalised to each individual, any changes in their needs, support would be amended and introduced into the support plan. All service users are supported to take risks and full assessments are in place. Service users are given every opportunity to make decisions about their lives and assistance is given as necessary.’ Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 13 Two staff wrote to us and the first said ‘The service ensures it meets the needs of the service users, giving them choices and allowing them to be as independent as possible.’ The other staff member wrote ‘We meet the service users needs and offer choices whilst promoting independence’ Before inspection service users said ‘I am able to do what I want to do, and choose where to go’ and I am ‘Usually able to make own decisions.’ Spending time at the home and talking to managers, staff and service users has confirmed all of the above. Service users are satisfied with the support they receive from staff who are guided by very well written care plans that comply with good practice. For example, we found care plans to be based upon life skills assessments, to address gender and cultural considerations, to focus on the individual’s strengths and personal preferences, communication styles and support needed with this. The minutes of staff meetings tell us that resident preference and choices are valued, with staff being reminded of this from time to time. We could not evidence that service users are fully involved in the development of their care plans but could see how service users had in their own writing completed information ‘about me’ to help to inform their care plans. Care plans are reviewed and review meetings are held with funding authorities to review the care provided. Minutes of those seen were very positive about how Avenue Road is meeting peoples needs. Risk assessments are in place to address risks particular to the individual and control measures are thorough. People do not feel unduly restricted by risk assessments that are in place. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 14 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, 17. Quality in this outcome area is adequate. Service users are involved in domestic tasks within their home and there are opportunities for outings and trips. These opportunities however are not sufficiently frequent, varied or individualised and although there are at times some good opportunities, service users reported being bored at times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In her annual return to us prior to inspection the manager told us that in order to improve the service ‘could incorporate more individualised activities and increase more cultural menus’. She added that they ‘plan to continue to monitor and improve lifestyles and implement any choices, wishes that the service users ask for’. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 15 Records looked at for individual service users show a lack of variety of activity and limited use of community facilities such as swimming pools, gyms, libraries, cinema, theatres, concerts etc for the young people who live there. Service users and staff value the outings they have from time to time. For example they had recently been to Cadburys World and were planning to go bowling at the weekend but discussion with staff confirmed that trips are usually organised as group trips rather than individual. Discussion with service users too indicated that they are ‘bored’ at times and that ‘there is nothing to do’. A service user said he would like to do sport activities. Discussion with staff provided a different perspective. They feel that he declines activities they offer him but records do not support this and lack of records do not help the service to monitor and review service provision, as the manager intends to. We talked through a week in the life of a service user, with the service user and with staff. We were told that Monday is bedroom-cleaning day, but further exploration of this showed this task only takes a short time and that there would be opportunities for other activities too. He appeared to feel his social opportunities are restricted by a lack of money and it is important that systems are put into place to support him to know how much money he has so his choices can be better informed. We could see that for the most part this person had unstructured time on Mondays, Tuesdays and Fridays. Staff said they could improve outings and holidays and other people have verified this including a response to a 2007 questionnaire that rated activities as ‘poor’. There was sufficient opportunity to see how service users are supported to have regular contact with family and friends by telephone and home visits. One relative appreciates how staff transports the service user to visit her regularly and this was planned for the evening of the inspection. Nobody needs support to eat and we were told that nobody is currently the subject of nutritional concern. People told us that staff choose what they eat but that they can have an alternative if the available meal is one they do not Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 16 like. Records show how service users are eating very different things from each other at breakfast time but that food provision is more uniformly provided at other meal times. Staff told us how one resident has cultural meals regularly, but records did not support this. Discussion with the manager informed us that this person is capable of making his own meal choices and that his family understand that by choice he would frequently choose ‘English’ meals. His care plan indicates that he can choose. We agreed with the manager the importance of evidencing the options given to him and the choices he has made, as he is not able to verbally comment on this. This is particularly important given the managers self-assessment in the annual return that they could increase cultural menus. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 17 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, 20. Quality in this outcome area is good. Personal support is provided in such a way that it meets service users preferences and expectations with privacy, dignity and independence being promoted. Generally the health needs of service users are well met with evidence of working in partnership with health agencies. Medication practices have improved substantially for the greater protection of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have received information from a range of sources that tells us that people’s personal care and health needs are well managed. A relative told us ‘‘Medical care – they are always onto it’ – ‘goes to optician, dentist and chiropodist’. Hygiene is kept up to scratch. She’s always neat and tidy and always looks lovely’ adding that privacy and dignity is ‘very good’ A service user told us ‘‘If I’m not feeling very well, staff check on me and take me to the Doctor’. Staff moan at me for not having a shower every day but its Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 18 for my own good.’ Another service user explained how he can have a shower because he prefers it to a bath and how it is always nice and warm. He said staff support him with showering and he is happy with this. Another service user told us staff check on her when she is showering because she has epilepsy. She was also satisfied with this. Perusal of risk assessments confirmed the need for this level of support. Our own observations of people and sight of their health records assure us that people are receiving appropriate personal care and health care. A health care professional told us that the care manager will always contact me to discuss the health care needs of individuals who live at the care home. Also that care staff ‘appear to have the right skills and experience to support individuals social and health care needs’. People’s health and well-being is supported by enabling them to take medication as it is prescribed to them. We asked three service users, all who said there are no problems with their medication and that they are always given it. We observed medication being administered. The staff member’s knowledge of how to administer medication was very good and she adhered to good practice throughout. Systems to support good practice are in place. For example only senior staff administer medication, a witness system is operated and so all staff have been appropriately trained. Storage of medication is organised, the supplying pharmacist supports the home by auditing their systems and there are no controlled drugs. Procedures for accounting for medication checked in and out of the premises are robust. It was positive to see that the pharmacist always provides printed administration records with any medication prescribed as a short course mid medication cycle. This avoids staff having to hand write prescribing direction and minimises the risk of human error. Service users are not receiving medication ‘as required’ to manage their behaviours and this ensures they are not inadvertently or deliberately over medicated. Medication records account well for tablets and creams administered but the Manager must ensure that where prescriptions say ‘use as directed’ that she confirms and records more detail about this with the medical practitioner to be sure that all staff administer consistently in the manner intended. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 19 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, 23. Quality in this outcome area is good. Relatives and service users know how to make a complaint but rarely need to. Service users feel safe and a range of systems is in place to maximise this. Whilst service users at Avenue Road have been protected, the service must act to protect the wider community in accordance with its statutory duties when concerns are known. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been made to the Service or to us about the service. Service users told us they would know what to do if something was wrong. They all said they would feel able to tell staff or Sarah, the Manager. Sarah said that all families have been sent information about how to complain should they need to. Satisfaction levels indicated in compliments and satisfaction surveys 2007 that relatives feel it has not been necessary to complain. All staff have undertaken training about abuse and protection. We discussed what they had learned in detail, giving several scenarios to check their understanding of their role and responsibilities. The answers staff gave were full and correct. Since the last inspection, the manager has reported an incident under adult protection procedures but investigation concluded it was a misunderstanding and no further action was taken. It is reassuring however that prompt action is taken when possible concerns are identified. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 20 Staff are also trained in physical intervention or restraint and again demonstrated a good understanding through discussion of the guiding principles. Staff explained that they don’t need to restrain at Avenue Road and never have but they were also able to demonstrate an understanding of more subtle forms of restraint such as the use of bedrails, lap belts and key code locks, none of which are in use. A service user explained how staff manage his behaviour. He said ‘I get angry and lose my temper really quick. Staff tell me to calm down. I sometimes get into trouble with Sarah, She doesn’t shout. I’m on my final warning now but I like it here. They respond in the best way and help me to calm down’. His relative in feedback to the service has said ‘‘everything you do for X, we have no complaints about. We think you manage him extremely well’. Likewise a further relative said to us ‘she can have ‘awful behaviours and they are managing it very well’. A staff member told us how service users monies are ‘more than safe’. She described how money is checked and handed over three times per day at each shift. She said how service users except one sign for their money and two staff sign too. We viewed financial records and they support the systems described to us. The Manager checks finances and we were told that the Manager’s manager also checks these during regulation 26 visits. It would help to better account for this if the regulation 26 reports explicitly state which records had been looked at, as currently reference to this is a bit vague and general. The Police and the Court system dealt with a previous matter to do with financial discrepancies within service users accounts at the home in May 2006. The outcome of this was known after the current provider had taken over responsibility. At the last inspection in July 2006, a requirement was made to follow this through by referring the individual involved to the national Protection of Vulnerable Adults (POVA) list. This prevents the person’s further employment in care and protects the wider community. There was no evidence that this has happened and it is of concern that it appears the Manager was left to do this when the responsibility is that of the provider organisation. The Manager said that she would follow this up without delay and bring it to the attention of her senior managers. We have also alerted Social Services. The Manager is aware of financial boundaries defining responsibilities for expenditure and although she could not provide records which she said were archived she confirmed that monies identified at the last inspection as owed to service users have been repaid. She also said she witnessed the previous provider being removed as named appointee for a service user and on this basis the requirements have been deleted. By contrast however, the requirement to ensure head office sends copies of personal bank statements to a service user has not been met. It is important to the service user that he is Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 21 provided with this information regularly as discussion with him indicated anxiety about not having enough money to do things he would like to do. It appeared that this is restricting his choices and opportunities unnecessarily. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 22 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, 30. Quality in this outcome area is good. Improvements to furnishings and décor are providing service users with a clean, pleasant and comfortable home that they appreciate and enjoy spending time in. The premises meet service users needs and are safely managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All previous requirements relating to the environment have been met. Comfortable, modern and readily cleanable easy chairs have been provided in the lounge. The building has been decorated throughout, some new carpets provided and the kitchen cupboards have been replaced. Several people told us that urgent matters are attended to quickly but that there can be long delays in approving funding for furniture. The Manager said however that two new wardrobes have now been ordered. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 23 The premises are clean, fresh and well heated. People told us that they are always warm enough and that there is always enough hot water. Staff test water temperatures twice a day to minimise the risk of scalding but records show temperatures don’t fluctuate and the manager may decide to review the need for this level of frequency. All the service users told us they really like their bedrooms and like to spend time in them. Service users have access to all parts of the premises and we observed people taking responsibility for chores and domestic tasks. All service users are mobile and the premises currently meet their needs without the provision of additional equipment or adaptations. We looked at the kitchen and laundry and found them to be well organised and clean. Hand washing facilities are available throughout. Clinical waste is not produced and the risks are low. We were satisfied given this and positive high scoring outcomes from a recent National Health Service (NHS) infection control audit of the home, not to assess this area in detail. Walsall NHS intends to revisit and reassess infection control next year. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 24 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, 36. Quality in this outcome area is good. Staff are very well supported and trained. They are competent and confident in their roles and respond to service users needs very well. Although everyone spoken to is satisfied with staffing levels, a requirement for improvement is not being met. Staffing levels are considered to be safe but improvements may increase opportunities for individualised activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection three staff including the manager were on duty. Discussions throughout the day also informed us that 3 staff are always on duty (except at night when there are 2). This does not enable the service to evidence how it is meeting the previous requirement of providing three plus one staff. Care staffing hours are also compromised by the fact that staff are multifunctional, meaning they also cook and clean as additional ancillary staff are not provided to detract from a more institutional model of care. Managers and staff are satisfied with current staffing levels and feel it is possible to meet service users needs. At this stage staff levels are not thought to be unsafe but given one service users need for two staff in the community, the presence of Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 25 only three staff will restrict his and others options. This may account for why the home is not performing as well with activities as it is in other areas of care it provides. We agreed also that the Manager should consider how current staffing levels would provide for the effective evacuation of residents during day and night time hours. Supervision records were not available to us but a supervision plan and discussion with two staff assured us that supervision takes place regularly and staff feel very well supported. Of the manager we were told ‘‘she’s one of the best with support’. ‘Can phone her late at night and can really rely on Sarah. She’s available every day and out of hours. I trust her advice’. Staff had a good understanding of the role and function of supervision and the required frequency to meet national minimum standards. It was positive to hear staff staff describe how they ask for supervision both formal and informal when they need it and this tells us that there is an established culture of supervision within the home. Staff performance was last appraised in March 2007. The manager described her team as ‘phenomenal’ and staff and relatives describe a happy and effective team. Staff speak highly of the training they are provided with and the manager said she prides herself on this. A staff member described how she has done all the training she needs to and how this and especially achieving her NVQ 2 helps her to meet service users needs. She described her ambition to continue with further NVQ training. A senior carer told us the same about the frequency and quality of training provided. Again she praised the manager for encouraging her and motivating her to achieve qualifications that exceed those required. Although the manager could not locate a team-training matrix, training profiles were available and up to date for individual staff members, records were organised and certification evidenced high quality and regular training. No new staff have been employed since the last inspection but the manager has obtained Common Induction Standards and is now confident that she could provide induction training to future new staff to the required level. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 26 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, 39, 42. Quality in this outcome area is good with the potential for excellence. One or two matters are outstanding and require attention. However overall on a dayto-day basis, the home is very well managed. All parties have confidence in the ability and commitment of the manager who is ensuring that the service is managed in the interests of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager feels well supported on a day to day basis by her manager and other senior managers. She said they are always available to advise her. She said that she does not feel disadvantaged by the fact that she does not receive supervision or by the fact that her performance has never been appraised. The manager is confident and competent. However structured supervision and Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 27 performance appraisal would help to identify areas where she requires support to develop herself and the service. Formal structures such as these would also help the provider to reflect on areas they need to take responsibility for to ensure omissions are met and to support the service to work towards excellence. Comments from all sources praised the manager. Examples of things we were told include: ‘I think Sarah does more than she needs to and more than she is paid to do – she manages great’. ‘She motivates and tells us a lot when we’ve done well and gives thanks. She tells us when we need to improve and is stern when she needs to be’ – staff member ‘We feel the manager is an excellent carer and a credit to you’ – relative ‘Excellent staff team and manager’ - relative ‘No concerns: Sarah and team are excellent’ - relative ‘I think Avenue Road staff do a very good job in providing an excellent service especially the care manager who shows great commitment to providing a high standard of service. Improvement seems to be ongoing.’ – health professional.’ The Manager prioritises her own training as well as that of her staff in order to keep her knowledge and skills up to date. She is qualified for role and has become a SKIP instructor (physical intervention). She also said she is applying to do a psychology degree. She has furthermore completed her external intermediate Health and Safety training as well as intermediate Food Hygiene, which exceeds the minimum standard of training, expected. She undertook fire training with staff in March 2007 and said she is keen to go on and obtain other externally validated health and safety training (NEBOSH). All staff have undertaken the required health and safety training in 2007 including infection control, appointed persons first aid, health and safety, food hygiene (meeting environmental health officers 2006 requirement), medication and fire training. Staff meetings are held regularly and are well attended. Minutes show us that staff are well lead, directed and praised but corrected when the need arises. The fire officer inspected the premises in 2007 and returned to assess progress. The Manager told us that the fire officer was satisfied with steps they had taken in response to suggestions but that a new roof in the laundry is to be imminently replaced with a more permanent structure to allow smoke detectors to be re sited. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 28 All maintenance and service documents we requested were provided and were up to date assuring service users that the premises are safely maintained and risks minimized. Checks on the home’s vehicle are now made regularly and recorded as required at the last inspection. An infection control score as assessed by the NHS of 94.1 is commendable. Regulation 26 visits are taking place and reports produced. Quality assurance systems are in place and relatives and service users are regularly consulted and their feedback is analyzed. Many of the comments have been quoted throughout this report but another is ‘I cannot think of anything extra you could do for X. She has experienced so many good things since coming here’. The Manager feels that the feedback has been used to improve the service especially social activity. Whilst this is the weaker area of service provision, we now judge lifestyle outcomes to be adequate as opposed to poor. Therefore can conclude that although, the manager reported having mislaid the homes development action plan, that the system is facilitating some improvement. Some domestic cleaning products, which could be hazardous, are being purchased and stored on the premises without seeking data to inform the risk and without an assessment of their risk being carried out. Hazardous chemicals are being stored away from service users in a locked cupboard but the manager has not understood that she needs to use the data sheets to carry out risk assessments. Therefore no risk assessments are in place for any of the products held on the premises. We asked the manager about general risk assessments for the premises and facilities. She located some but found them to be dated 2005. We agreed that these must be reviewed to ensure they currently address the full range of risks and controls needed. The manager informed us that there have been no accidents. Perusal of records indicates that one service user went to hospital having chipped a bone in his foot following a seizure, which the manager had forgotten about. It was a previous requirement to report all accidents to us and a hospitalization is reportable to us under Regulation 37. This requirement therefore has not been met. It may seem like a minor oversight that does not in real terms affect outcomes for service users. However we use this information in between inspections to help us to judge whether the service quality is changing and trends in reported issues may lead us to consider bringing forward an inspection date. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 29 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 2 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 2 34 X 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 30 Yes 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 YA23 Regulation 13(6) Requirement A referral to the Protection of Vulnerable Adults Register must be made to conclude the adult protection 2006 investigation. This will also help to protect vulnerable people in the wider community. Original target date of 30.09.06 not met. Timescale for action 14/03/08 2 YA34 19 All staff files must include information as listed in Schedules 2 and 4 of the care Homes Regulations 2001. This will ensure compliance with regulations to protect service users when newly recruited staff are appointed. Original target date of 1/12/06 set. Not assessed at this inspection as recruitment records not accessible. Informed no staff recruited since last inspection. 07/03/08 3 YA42 13(3) All accidents must be reported to CSCI in line with Regulation 37 to comply with legal responsibilities and to ensure that such incidents can be DS0000020834.V352711.R01.S.doc 07/03/08 Avenue Road Version 5.2 Page 31 monitored. Requirement outstanding from target date of 27/09/05 4 YA42 13(3) Steps must be taken to identify and reduce environmental risks within the premises to promote service users safety and welfare. (Previous requirement relating to COSHH assessments outstanding from original target date 1.12.06. This inspection also found general risk assessments to not have been reviewed since 2005) 31/03/08 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 YA1 Good Practice Recommendations The Statement of Purpose and Service User Guide should be reviewed, updated, should include up to date weekly fees and be in accessible formats (This review should include reviewing the needs of the resident admitted out of category and an application to vary the category of registration should be considered.) 2 YA5 All service users contracts of residency should be reviewed and should be in accessible easy read formats. This was set as a requirement previously with target date of 1.12.06 and has not been met. 3 YA14 Steps should be taken to provide more individual social activities and outings that tally with people’s individual hobbies and interests. This may include reviewing or restructuring staffing levels. Staff should ensure that when opportunities are offered that are declined by the service user that this is recorded to enable monitoring and quality review. Steps should be taken to enable service users to actively be involved in menu planning. Choices available to and made by service users should be evidenced to DS0000020834.V352711.R01.S.doc Version 5.2 Page 32 4 YA17 Avenue Road demonstrate that appropriate alternatives are available to service users to meet their cultural requirements, dietary preferences and needs. 5 YA20 Guidance should be available to inform staff where on the body prescribed creams should be applied. This originally was a requirement with a target date of 7/9/06 and has not been met. 6 YA20 7 YA23 Guidance should be available to inform staff how to administer medication and creams prescribed ‘as directed’ to ensure it is administered consistently and as intended. This guidance should be obtained from a medical practitioner / prescriber. Copies of bank statements held on behalf of a service user should be provided to him at the home to enable him to know how much money he has to relieve anxiety and to help him to make appropriate choices about his life and expenditure. This originally was a requirement with a target date of 30/9/06 and has not been met. 8 YA39 The home should have an annual development plan – requirement originally made March 2004 and is not evidenced as met. Avenue Road DS0000020834.V352711.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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