Care Home: Cromwell Avenue (9)

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What the care home does well People using the service said that they were being well looked after and that they were happy with the support they were receiving from the staff team. Prospective individuals, significant others and potential placing authorities are provided with relevant information about services and encouraged to visit the care home. The assessment and admission process is robust, which ensures that the needs of new residents are identified and care is planned accordingly. Care plans are `person centred` and reviewed on a regular basis to address the changing needs of individuals. The care planning approach involves the resident and significant others, in order to ensure the needs, wishes and aspiration of the individual are at the centre of service delivery. The environment is reasonably well maintained and a good standard of cleanliness was evident throughout those areas viewed. The care home benefits from a rear garden, which are well utilised by people using the service. The systems in operation including complaint and safeguarding adults should offer adequate protection to people using the service. There is a competent and trained staff team who are knowledgeable about the individual needs of people using the service. In relation to equality and diversity, the home has this policy in place and staff spoken to were aware of it and ensured that people were treated equally irrespective of their age, race, disability, religious beliefs, cultural background and sexual orientation. What has improved since the last inspection? The home continues to support, enable and empower the residents in meeting their identified needs. What the care home could do better: The home should update the Statement of Purpose and include the contact detailes of the Care Quality Commission so that people wishing to contact the Commission are able to do so. Formal supervision should be provided to all care staff on a regular basis so that they are supported, supervised and their work appraised. Key inspection report Care homes for adults (18-65 years) Name: Address: Cromwell Avenue (9) 9 Cromwell Avenue Cromwell Avenue (9) Cheshunt Herts EN7 5DJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bijayraj Ramkhelawon     Date: 0 1 0 4 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 23 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 Homes for Adults (18-65 years) 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 23 Information about the care home Name of care home: Address: Cromwell Avenue (9) 9 Cromwell Avenue Cromwell Avenue (9) Cheshunt Herts EN7 5DJ 01992622032 01992622032FP Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Residential Community Care Services Ltd Name of registered manager (if applicable) Maria Bridget Walker Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 9 Cromwell Avenue is a care home first registered in August 2004, providing personal care and accommodation for four young adults who have a learning disability and associated mental disorder. The home is owned and operated by Residential Community Care Services (RoCCS), a private organisation. This is the third home that RoCCS established in Hertfordshire. The home currently consists of a four bedroom terraced house situated in a residential street in Cheshunt, next door to the GPs surgery and across the street from a small Care Homes for Adults (18-65 years) Page 4 of 23 Over 65 0 0 5 5 Brief description of the care home grocery shop. It is in walking distance of other local shops and parks, and close to public transport. A further bedroom is being added. All the bedrooms are single, with en-suite facilities. The garden contains a patio and grass area, with a pond protected by a small fence, there is also an area at the back of the garden where domestic rabbits and guinea pigs are housed. The current weekly accommodation charge ranges from £1143.00 to £1722.49. A copy of the Service Users Guide, Statement of Purpose and the last inspection report can be obtained from the manager of the care home on request. Care Homes for Adults (18-65 years) Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out on the 1st April 2010 and took one day. It included talking to residents, staff, examining care plans, staff files, staff training records, fire safety procedures, medicine records, maintenance records, all other records and documents and a tour of the premises. Care Homes for Adults (18-65 years) Page 6 of 23 What the care home does well: What has improved since the last inspection? 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. Care Homes for Adults (18-65 years) Page 7 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 using the service can be assured that their needs would be assessed and met. Information about the home is available so that people would be able to make a decision whether to move in or not Evidence: Adequate information about the home including a copy of the Statement of Purpose and Service Users Guide was available to current and prospective residents. However the Statement of Purpose should be updated with the Care Quality Commissions contact details. Care plans examined showed that an assessment of individuals needs was carried out prior to moving in. The home also has good arrangements to enable new residents to familiarise themselves with the home prior to moving in. Care Homes for Adults (18-65 years) Page 9 of 23 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their identified needs would be met and that they would be enabled to live the lifestyle they choose. Evidence: Each person has a person centred plan of care based on their views about how they wish to be supported from day to day and longer term goals. Residents understand the information kept about them in their individual care plans and staff support them to understand the information with the photos, pictures, symbols and is written in plain language. The care plans are reviewed on a regular basis and any changes are reflected within the support plan. Each care plan includes the assessment of needs, various risk assessments, residents profile, history, daily records, day care programme and a health care plan. Family, advocates and professionals from specialist services are also involved in the assessment process and reviews. Residents spoken to said that they were being well looked after and were happy with the support they received. Care Homes for Adults (18-65 years) Page 10 of 23 Evidence: Care Homes for Adults (18-65 years) Page 11 of 23 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported to engage in appropriate activities, accessing local community amenities and that their rights are respected. Evidence: Each care plan has a programme of activities for each resident and the service actively supports people to be independent and involved in all areas of daily living in the home. This includes where appropriate, taking responsibility for shopping, planning meals and meal preparation. Residents are encouraged and supported to maintain relationships with families and friends. The home has several pets and one of the residents takes responsibility for cleaning out and caring for the pets, which she said she enjoys very much. Meals are well balanced and nutritional and the home caters for varying dietary needs of the residents. They are involved in meal planning and have a wide variety of choice Care Homes for Adults (18-65 years) Page 12 of 23 Evidence: on offer from the menu. On the day of the inspection one of the residents were being supported by a member of staff to make cakes that are shared between the residents. Care Homes for Adults (18-65 years) Page 13 of 23 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their individual personalities through the choices they make regarding personal care, food, clothing and accessories. They are able to access local community health services to maintain and promote a healthy lifestyle. Evidence: Care plans are detailed and comprehensive and person centred. Staff are aware of the needs of individuals and are able to help and provide support as appropriate. The practice for the management and administration of medicines are carried out in a safe manner. The home works closely with other professionals and specialists for advice and support to help the residents, their families and staff. Care Homes for Adults (18-65 years) Page 14 of 23 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 has an open culture that allows people using the service to express their views, and concerns in a safe and understanding environment. Evidence: The home has a complaints procedure and information on complaints is also included in the Service Users Guide. Residents meetings are held and a simplified version of the complaint process is discussed on a regular basis to remind residents of their rights. Residents spoken to said that they would raise their concerns with the staff and were happy with the support they received from their key workers. No complaints have been received in the last twelve months. The home has a copy of the Hertfordshire procedures on Safeguarding Adults. Staff spoken to confirmed that they are familiar with the procedures and staff records showed that they have received training on the safeguarding adults. An element of safeguarding adults is also covered in the induction programme for all new staff members and those people undertaking the NVQ assessment. Care Homes for Adults (18-65 years) Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this 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 using the service are supported in an environment that is homely and comfortable. Evidence: The home was reasonably well maintained and furnished in a domestic style to provide a homely, comfortable and safe environment. All bedrooms viewed were personalised to reflect individuals interest and sensory needs. A good standard of cleanliness was evident throughout those areas viewed. Food items were appropriately stored in fridges and temperatures, recorded daily. The home has an infection control policy and procedures in place and staff encourage residents to follow good hygiene practice. Arrangements for the storage and disposal of domestic and clinical waste remain satisfactory. Staff members spoken to are conversant with infection control procedures. Care Homes for Adults (18-65 years) Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this 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 using the service do benefit from the care and support they receive from a competent and qualified staff team and that they feel protected by the homes recruitment policy and practices. Evidence: Information gained from duty roster and staff members provides evidence that the day and night staffing levels remain adequate to meet the needs of the residents. Staff members have the necessary skills and they receive appropriate training to meet the varying needs of the residents. Staff spoken to indicated that they have opportunities for relevant training and this gives them greater confidence to do their jobs. Staff were very knowledgeable about the needs of individuals whom they were supporting and caring for. Currently, there are 8 care staff employed, 6 of whom have completed the NVQ Level 2. One care staff has just started the NVQ Level 2 and another is currently undertaking this training. Six staff files were examined and these were found to contain all the required documents including two written references and CRB checks were carried before an offer of employment was made. Care Homes for Adults (18-65 years) Page 17 of 23 Evidence: Staff also confirmed that they received support from the management team and that senior members of staff were approachable and available for advice as and when needed. Staff spoken to confirmed that one to one formal supervision are not being provided on a regular basis. Care Homes for Adults (18-65 years) Page 18 of 23 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 using the service can be assured that their health and welfare are protected by the policies and procedures and a strong ethos of being open and transparent in the running of the home. Evidence: Residents and staff spoken to said that the manager was supportive and approachable. The implementation of a number of systems including assessment and admission process, care planning and review, consultation and communication, recruitment, induction and training of staff ensures that the home operates in an manner that benefits people using the service and the staff team. The home has a quality assurance system in place and seek the views of people using the service, relatives, staff and other interested parties. All statutory records were available for inspection and maintained in accordance with legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that people using the service can access their records and information held about them in accordance with the Data Protection Act 1998. Care Homes for Adults (18-65 years) Page 19 of 23 Evidence: There were policies and procedures in place to ensure that the health, safety and welfare of people using the service and staff are promoted and protected. These records were accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. Regular checks on hot water temperatures (weekly) and moving and handling equipment were recorded. A valid Employers Liability insurance certificate was displayed and expires on the 30th September 2010. Care Homes for Adults (18-65 years) Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should be updated with the Care Quality Commissions contact details so that people wishing to contact the Commission are able to do so. Formal supervision should be provided to all care staff on a regular basis so that they are supported, supervised and their work appraised. 2 36 Care Homes for Adults (18-65 years) Page 22 of 23 Helpline: 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). 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