Care Home: Lingfield Avenue, 11

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What the care home does well Most of the verbal feedback with received from the people who use the service, the expert by experience, and staff who work there, was in the main very positive about the home. Lots of people we spoke with told us they felt things had significantly improved in the past year. Typical comments included, `the managers around more and we are less reliant on agency staff`, ` in-house activities are better now, but i would like to get out more`, and `theres a nice atmosphere about the place, but it could do with redecorating`. All the staff met were always observed interacting with the people using the service in a very kind, respectful and professional manner. It was clear the staff team are familiar with the needs, wishes, and preferences of all the people who use the service. The atmosphere in the home remained extremely friendly and relaxed throughout the course of these two site visits. What has improved since the last inspection? The service has made a significant number of improvements in the past year, including meeting all the Requirements and good practise Recommendations we made at the previous inspection. As recommended in the services last two inspection reports a new easy read version of the homes Guide has been developed. The information contained in the new Guide is meaningful and accessible. Copies of the Guide are pinned to the new notice board in the entrance hall. A new care plan format has been introduced, which all the people who use the service were actively involved in developing. These plans are highly individualised and person centred, focusing on an individuals strengths, personal preferences, who and what is important to them, how to keep safe, their goals and aspirations, and how they make decisions in their life. The new plans can also be easily read by the people who use the service and staff who are not familiar with the individual to deliver a personalised and consistent person centred service. As required in the services last report plans are now being reviewed regularly, and as the individuals needs change. As recommended in the last report the services arrangements for ensuring the people who live at Lingfield Avenue are continually consulted about how their home is run. People who use the service have more opportunities to influence key decisions in the home. For example, people who use the service regularly attend residents meetings, have to one to one sessions with their keyworkers, can read all the information displayed on the new notice boards, and are always consulted about what meals they want to eat and activities they would like to engage in. The service is much better at listening to the people who use the service and acting upon what they say. For example, people who use the service told us the manager asked them about having a gazebo in the garden before any decisions were taken to erect one. The variety of opportunities the people who use the service have to engage in in-house activities continues to improve and as recommended in the services last report peopleare getting out more. However, there is a general consensus of opinion expressed by a number of the people who use the service, the expert by experience, and the services team leader and activities coordinator, that the home could do more to ensure people had far more opportunities to participate in meaningful community based activities. People who use the service told us they would have liked to go on more day trips last year. An additional fourth member of staff now works early shifts to ensure there are always sufficient numbers of staff on duty to cover this traditionally peak period of activity. We highly commend the service for taking such a proactive and flexible approach to planning duty rosters, which are clearly based on the needs and wishes of the people who use the service, and not staffs preferences. As recommended in the services last report the manager has recently recruited a number of male suport workers to address the gender imbalance that previously existed between the people who use the service and the very female dominated staff team. Staff are also receiving formal one to one supervision sessions with qualified Seniors on a more regular basis. The manager is spending a lot more time at Lingfield Avenue. Records show us Roger now spends at least four mornings a week there. As recommended in the last report both the services team coordinators, who are responsible for running the home in Rogers absence, have received training from Scope regarding their new managerial roles and responsibilities. Arrangements for ascertaining the views of the people who use the service and their representatives has also improved in the past year. For example, we are aware that the manager has carried out a quality assurance audit involving all the people who use the service and staff to find out what people felt needed to be improved at Lingfield Avenue. As a result of this internal assessment the manager has produced a comprehensive action plan that sets out how the service intends to address all the issues identified at the review. The activities coordinator also told us she now asks the people who use the service on a regular basis what they think about the activities on offer and what she could do to improve them. As required in the last two reports the outcome of monthly inspections of the home undertaken by Senior representatives of Scope are now kept on site and were made available for inspection on request. Finally, as required in the last report all night staff who work at the home have participated in at least one fire drill in the past three months and a suitably qualified professional has tested the service water heating system for legionella in the last year. What the care home could do better: All the positive comments made above about the service improving notwithstanding the relatively new manager is the first to recognise there remains considerable room for further development: Gaps in staff training. All staff that work at the service must continually refresh their safeguarding adults training. This will ensure staff have the necessary knowledge and skills to recognise, prevent and report abuse should they witness or suspect ithappening within the home in order to keep the people who use the service safe from harm. The manager should also establish a time specific rolling programme which sets out clearly how he intends to address all his current staff teams training needs as identified in the homes training assessment. The rather worn out and damaged kitchen must be repaired and/or replaced with new units within six months. This will ensure the people who use the service and staff live and work in a comfortable environment that is also fit for purpose of preparing large numbers of meals and drinks on a regular basis. The overall decor of the place is well overdue an upgrade. The providers should establish a time specific rolling programme that makes it clear what areas of the property they plan to redecorate and what soft furnishings are going to be replaced. A copy of the programme should then be sent to us. These changes will ensure the people who use the service live in a more comfortable and homely environment. The outcome of monthly one to one meetings people who use the service have with their designated keyworkers should be recorded. This will enable anyone authorised to view these minutes to determine whether or not the opinions of the people who use the service are being listened too, and taken seriously. Despite recent improvements with regards in-house activities, community based ones are not so prevalent. People using the service should be offered far more opportunities to engage in more `meaningful` and stimulating activities in the wider community, especially day trips. This will ensure that the social interests and lifestyle expectations of the people who use the service are met. Arrangements for enabling the people who use the service to do more things for themselves has improved, but there still needs to be an up to date record of these individualised programmes. The records should show us how the service is actively encouraging and supporting people who live at Lingfield Avenue to maintain and develop their independent living skills. This will enable anyone authorised to inspect these records to determine whether or not staff are promoting the rights of the people who use the service to live their lives as independently as is reasonably practicable. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lingfield Avenue, 11 11 Lingfield Avenue Kingston Upon Thames Surrey KT1 2TL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lee Willis     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Lingfield Avenue, 11 11 Lingfield Avenue Kingston Upon Thames Surrey KT1 2TL 02085462905 02085460947 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : SCOPE care home 14 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 14 14 The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical disability - Code PD Date of last inspection Brief description of the care home Lingfield Avenue is a large detached property offering accommodation and personal support for up to fourteen adults with physical and learning disabilities. Roger Hughes, who has been in operational control of the service since August 2007. Roger successfully completed a fit person interview with us in 2008 and is now the registered manager of Lingfield Avenue. Roger is also responsible for running two other registered services in West London, which are also owned by Scope. The home is close to good transport links and is relatively near Surbiton town centre, with its good leisure and community facilities. The service no longer has its own transportation, but vehicles are hired as and when required. The property is decorated and furnished to an adequate standard, but is suitably adapted to maximise peoples independence. The Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home majority of the people who use the service choose to have their own single occupancy bedrooms. A married couple currently occupies the self-contained flat on the top floor. The open plan layout of the ground floor makes the communal areas wheelchair accessible. This consists of a large kitchen/dinning area, a main lounge that can be partition in two, entrance hall, laundry room and separate storage area, larder, new staff room, two offices, and a staff sleep-in room. The garden at the rear of the property is well maintained and is also wheelchair accessible. The home has developed clear information to help people who use the service and their representatives to understand what facilities and services are provided. The Scope currently charges between 30,000 and 70,000 pounds a year for each placement. Care Homes for Adults (18-65 years) Page 5 of 34 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: two star good 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: The outcomes the people who live at 11, Lingfield Avenue experience has significantly improved since the services last Key inspection. Consequently, we have increased this previously rated adequate 1 star performing service to a good 2 star performing one. From all the available evidence we gathered during this key inspection it was clear the service now has more strengths than areas for improvement. The people who use the service are being kept safe, the home is much better managed, and National Minimum Standards under key outcome groups are generally met. We are confident the manager will continue to recognise and rectify all the shortfalls that have emerged during this inspection. We spent 7 hours at the service in total spread over two days. During the site visit we spoke with 6 people who currently live at 11, Lingfield Avenue, the Care Homes for Adults (18-65 years) Page 6 of 34 regional and registered managers of the home, an acting Team coordinator, an activities coordinator, and 4 support workers. We also made telephone contact with the manager of a local day centre attended by a number of the people who use the service. During these visits we also looked at various records and documents including, the care and health action plans for 3 people who use the service. The remainder of the visit was spent during the premises and grounds. Two of our easy read questionnaires were returned to us by people, who use the service. The manager completed and returned our Annual Quality Assurance Assessment (AQAA) when we asked for it. This self-assessment document tells what the providers think they do well, what has improved since the homes last inspection, and what the manager thinks they could do better. Finally, an expert by experience, who is a person who has a shared experience of using care services joined us on the morning of the first day of this inspection. The expert by experience spoke to 4 people who use the service and the manager. The expert helps us get a better picture of what it is like to live in a care home and key parts of this report are based on what the expert by experience told us. We used a lot of the evidence he provided us with to support the judgements we made about the homes overall performance. What the care home does well: What has improved since the last inspection? The service has made a significant number of improvements in the past year, including meeting all the Requirements and good practise Recommendations we made at the previous inspection. As recommended in the services last two inspection reports a new easy read version of the homes Guide has been developed. The information contained in the new Guide is meaningful and accessible. Copies of the Guide are pinned to the new notice board in the entrance hall. A new care plan format has been introduced, which all the people who use the service were actively involved in developing. These plans are highly individualised and person centred, focusing on an individuals strengths, personal preferences, who and what is important to them, how to keep safe, their goals and aspirations, and how they make decisions in their life. The new plans can also be easily read by the people who use the service and staff who are not familiar with the individual to deliver a personalised and consistent person centred service. As required in the services last report plans are now being reviewed regularly, and as the individuals needs change. As recommended in the last report the services arrangements for ensuring the people who live at Lingfield Avenue are continually consulted about how their home is run. People who use the service have more opportunities to influence key decisions in the home. For example, people who use the service regularly attend residents meetings, have to one to one sessions with their keyworkers, can read all the information displayed on the new notice boards, and are always consulted about what meals they want to eat and activities they would like to engage in. The service is much better at listening to the people who use the service and acting upon what they say. For example, people who use the service told us the manager asked them about having a gazebo in the garden before any decisions were taken to erect one. The variety of opportunities the people who use the service have to engage in in-house activities continues to improve and as recommended in the services last report people Care Homes for Adults (18-65 years) Page 8 of 34 are getting out more. However, there is a general consensus of opinion expressed by a number of the people who use the service, the expert by experience, and the services team leader and activities coordinator, that the home could do more to ensure people had far more opportunities to participate in meaningful community based activities. People who use the service told us they would have liked to go on more day trips last year. An additional fourth member of staff now works early shifts to ensure there are always sufficient numbers of staff on duty to cover this traditionally peak period of activity. We highly commend the service for taking such a proactive and flexible approach to planning duty rosters, which are clearly based on the needs and wishes of the people who use the service, and not staffs preferences. As recommended in the services last report the manager has recently recruited a number of male suport workers to address the gender imbalance that previously existed between the people who use the service and the very female dominated staff team. Staff are also receiving formal one to one supervision sessions with qualified Seniors on a more regular basis. The manager is spending a lot more time at Lingfield Avenue. Records show us Roger now spends at least four mornings a week there. As recommended in the last report both the services team coordinators, who are responsible for running the home in Rogers absence, have received training from Scope regarding their new managerial roles and responsibilities. Arrangements for ascertaining the views of the people who use the service and their representatives has also improved in the past year. For example, we are aware that the manager has carried out a quality assurance audit involving all the people who use the service and staff to find out what people felt needed to be improved at Lingfield Avenue. As a result of this internal assessment the manager has produced a comprehensive action plan that sets out how the service intends to address all the issues identified at the review. The activities coordinator also told us she now asks the people who use the service on a regular basis what they think about the activities on offer and what she could do to improve them. As required in the last two reports the outcome of monthly inspections of the home undertaken by Senior representatives of Scope are now kept on site and were made available for inspection on request. Finally, as required in the last report all night staff who work at the home have participated in at least one fire drill in the past three months and a suitably qualified professional has tested the service water heating system for legionella in the last year. What they could do better: All the positive comments made above about the service improving notwithstanding the relatively new manager is the first to recognise there remains considerable room for further development: Gaps in staff training. All staff that work at the service must continually refresh their safeguarding adults training. This will ensure staff have the necessary knowledge and skills to recognise, prevent and report abuse should they witness or suspect it Care Homes for Adults (18-65 years) Page 9 of 34 happening within the home in order to keep the people who use the service safe from harm. The manager should also establish a time specific rolling programme which sets out clearly how he intends to address all his current staff teams training needs as identified in the homes training assessment. The rather worn out and damaged kitchen must be repaired and/or replaced with new units within six months. This will ensure the people who use the service and staff live and work in a comfortable environment that is also fit for purpose of preparing large numbers of meals and drinks on a regular basis. The overall decor of the place is well overdue an upgrade. The providers should establish a time specific rolling programme that makes it clear what areas of the property they plan to redecorate and what soft furnishings are going to be replaced. A copy of the programme should then be sent to us. These changes will ensure the people who use the service live in a more comfortable and homely environment. The outcome of monthly one to one meetings people who use the service have with their designated keyworkers should be recorded. This will enable anyone authorised to view these minutes to determine whether or not the opinions of the people who use the service are being listened too, and taken seriously. Despite recent improvements with regards in-house activities, community based ones are not so prevalent. People using the service should be offered far more opportunities to engage in more meaningful and stimulating activities in the wider community, especially day trips. This will ensure that the social interests and lifestyle expectations of the people who use the service are met. Arrangements for enabling the people who use the service to do more things for themselves has improved, but there still needs to be an up to date record of these individualised programmes. The records should show us how the service is actively encouraging and supporting people who live at Lingfield Avenue to maintain and develop their independent living skills. This will enable anyone authorised to inspect these records to determine whether or not staff are promoting the rights of the people who use the service to live their lives as independently as is reasonably practicable. 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 set out 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 10 of 34 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 11 of 34 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 who use the and their representatives have access to all the information they need to make an informed decision about whether or not the service is right for them and/or loved one/client. The impact any new referral would have on the people already living at the home is always taken into account when assessing the suitability of a prospective new admission. Evidence: As recommended in this services last inspection report an easy read version of the homes Guide had been developed which was written in plain English and illustrated with pictures. A team coordinator told us the Guide had been reviewed i the past 12 months and up dated accordingly to reflect all the changes in provision that had occurred in that time. The expert by experience wrote in his report that there is a notice board in the hallway with Scopes mission statement pinned to it. The complaints procedure is also available in print and makaton on this board. Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: Both the easy read surveys that were returned to us by two people who use the service, with help from their relatives, ticked the yes boxes in response to the questions - Were you asked if you wanted to move in, and before you did so did you get enough information about it so you could decide if it was the right place for you? One relative wrote - i visited the home myself prior to my love one moving in. The manager told us he had not accepted any new referrals in the past year. Roger Hughes demonstrated a good understanding of what constituted best practise regarding new admissions and was very clear that he would not accept any new referrals without first considering the impact this would have on the people already residing at Lingfield Avenue. Care Homes for Adults (18-65 years) Page 13 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The services care planning arrangements have significantly improved since its last inspection. Care plans are now far more person centred and reflect what is important to the individual, what their capabilities are, and what support they need to achieve their personal goals and aspirations. The services arrangements for ensuring the people who use it are consulted on, and can participate in, all aspects of life in their home have also significantly improved in the past 12 months. The people who use the service have far more opportunities to participate in one to one and group meetings, care plan reviews and have access to more information regarding whats going on at Lingfield Avenue on a daily basis. The service has satisfactory arrangements in place regarding the assessing, managing and reviewing of identified risks. This minimises the likelihood of people who use the service being harmed, whilst ensuring they retain their right to take responsible risks and live their lives as independently as reasonably practicable. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: A team coordinator told us all the people who use the service had been actively involved in drawing up new care plans which were far more person centred. We looked at the care plans for three people who use the service, which set out in greater detail what everyones unique strengths, personal preferences, daily routines, and aspirations were. The new care plans were also illustrated with various pictures and symbols to make it easer for people who use the service to read. Staff met told us they had helped the people they key work to develop their new care plan and found them to be much better working documents than the previous plans as the information they contained was easier to access and therefore follow. As required in the services last inspection all three care plans viewed had been reviewed in the past six months and up dated accordingly to reflect any changes in provision. Minutes of these care plan reviews also revelled people who use the service, their key workers, family and care managers had all been invited to attend these meetings. The expert by experience asked four people who use the service - Do you have a care plan? How often is it reviewed, and who is involved in the process? All four individuals said that they had a care plan, and that they understand it, but 3 of them could not tell me how often they have a one to one to discuss their plan. The team coordinator showed us a list that revealed all 12 of the pope who currently use the service have both a designated and second co-keyworker. Staff met demonstrated a good understanding of their keyworker responsibilities and two told us they regularly arrange one to one sessions with the individuals they keywork in order to ascertain their views about how their home is being run. However, a team coordinator and all the staff spoken with about these sessions told us they did not record the outcomes of these meetings. We recommend keyworker sessions are recorded from now on. As recommended in the services previous report it was positively noted that arrangements for enabling the people who use the service to get more involved in the day-to-day running of their home had significantly improved. During a tour of the premises it was noted that a new wipe clean board had been put up in the entrance hall, which used plane language and symbols to let the people who use the service know what activities were available each day. Staff photographs, easy read minutes of the service users last monthly meeting, the homes last CSCI inspection report, and a easy read version of the homes complaints procedures were also conspicuously displayed on another notice board near the front door. Two people who use the service told us they both liked the idea of the new information boards as it enables them to find out for themselves what was going at Lingfield Avenue on a daily basis. All the risk assessments included in the three care plans examined in depth were a Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: combination of generic as well as very individualised management strategies that covered every aspects of peoples unique personal, social and health care needs. All the risk assessments looked at had been reviewed in the past three months and up dated accordingly by designated keyworkers to reflect any changes in need or circumstances. The team coordinator met demonstrated a good understanding of her risk assessing responsibilities and was very clear that the people who use the service should not be denied the opportunity to take responsible risks in order to enable individuals to develop their independent living skills. Care Homes for Adults (18-65 years) Page 16 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The opportunities the people who use the service have to maintain and development their independent living skills has significantly improved, although this ethos should be formally recognaied in care plans. Furthermore, the number and variety of social, leisure and recreational activities the people who use the service have the opportunity to participate in has also improved in the past 12 months, although the service should be doing more to ensure individuals get out more and enjoy more meaningful activities in the local community, espcailly day trips. The dietary needs and preferences of the people who use the service are well catered ensuring they are offered daily variation and choice at mealtimes. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: 100 of the surveys returned to us indicated that the people who use the service could do what they wanted during the day, in the evening, and at the weekend. All the people spoken with during this site visit, which included the homes part time activities coordinator, told us the people who use the service had far more opportunities to pursue meaningful leisure pursuits within the home. We looked at weekly activities schedules included in three new care plans, which the activities coordinator told us people who use the service helped develop. During a tour of the premises the activities coordinator was observed actively encouraging peole who use the service to join in an art session. Staff now maintain appropriate records of all the activities the people who use the service choose to participate in, as well as those they had declined to join in with. The team coordinator told us these new activity schedules were very flexible and were used by staff as a rough guide to help them plan with the people who used the service what they might wish to do each day. Entries made in these records showed us people who use the service were doing a lot more of the things they enjoyed at more regular intervals. However, all these positive comments made above notwithstanding, both the team and activities coordinators conceded that although people who use the service were engaging in more community based activities their remained considerable room to further improvement in this area. The expert by experience asked four people who used the service about what opportunities do you have to engage in community activities, social, leisure & recreational? How often do you go out? Three of the service users go shopping on Saturdays. One service user has certificates from the local college in computers, another is hoping to go to college in May, access permitting. None of them have social lives outside of the home and none of them visit the pub, cinema etc. All the people who use the service and staff we spoke with during this inspection told us hardly any day trips had been organised in 2008, although most had been on holiday. Daily diary notes looked at in depth indicated the people who used the service had not engaged in very many meaningful and/or fulfilling social activities outside their home in recent months. We agreed with the comments made by the expert by experience, who wrote - My main concern is about the isolation that the residents are experiencing. While there is debate about the minibus issue I think more should be done about training people to use public transport. It`s not enough to just say theres a bus stop use it. There is the lack of confidence many disabled people have in the wider community. People have to be encouraged to go to destinations otherwise they become institutionalised. Scope and social services have to encourage better outreach from the local community so the residents have places to aim for when they go out. As one resident told me I asked about voluntary work, but have heard nothing since. I feel this sums it up. We recommend people who use the service are provided with more opportunities to Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: engage in appropriate community based leisure activities. Progress made by the service to achieve this aim will be assessed at its next inspection. All the staff spoken with at length told us the service is now much better at encouraging the people who live at Lingfield Avenue to do more for themselves with appropriate staff support. Chores people who use the service regularly engage in include, cleaning their bedrooms, helping staff prepare food, and setting the dinning room tables for meals. The relatively new manager is commended for placing more emphasis on the strengths and rights of the people who use the service to do more for themselves, although we do recommend this ethos is formally recognised in individuals care plans in the form of a structured programme for promoting independent living skills. The services visitors book, which staff ensured we signed on arrival in line with the providers visitors policy and best practise, indicated that the home continues to receive lots of guests including, the relatives and professional representatives of the people who use the service. The expert by experience told us - Two people see family members on a regular basis, another sees family occasionally. Staff were observed using menu cards on both days of this inspection to find out and record what people who used the service would like to eat for lunch. The two meal choices on the cards were reflected on that days menus, which were conspicuously displayed in the entrance hall. Staff were also observed preparing and serving both choices of meals at lunch as ordered by the people who use the service. During the morning of the first site visit staff were observed actively encouraging and supporting several people who use the service too make cakes. The expert by experience asked four people who use the service - if there was a good food choice? Is it good Quality, and is there enough of it? All four service users met said they were happy with the food, and they get enough. They can get more if they want it. Its getting better one user said. Care Homes for Adults (18-65 years) Page 19 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. Staffs medication recording, monitoring and storing practises are sufficiently robust to minimise the risk of the people who use the service being harmed and/or abused. Evidence: All the people who use the service were suitably dressed in well-maintained clothes that were appropriate for the time of year on both days of this inspection. Two people who use the service told us they can get up and go to bed when they want, and always choose what they are going to wear each day. Manual handling assessments were made available in request of the three people whose care we were case tracking. Since the last inspection new health care action plans have been introduced, which set out in detail individuals health care needs and the suport they require to have them met. Health action plans viewed identified individuals exercise programmes, dietary requirements and weight charts, medication Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: regimes, and the outcomes of all the appointments they had attended with various health care professionals. These records indicated advice and input is continually sought from various outside health care professionals including, GPs, specialist community nurses, and dentists. None of the people who use the service were admitted to casualty since the last inspection and all the accidents people were involved in were minor. All these accidents, which mainly pertained to falls, had been appropriately recorded by staff. No recording errors were noted on any of the medication administration records (MAR) sheets used in the past 3 months and there was a clear audit trail of all the medicines received into the service on behalf of the people who lived there. The services medication monitoring arrangements also remain robust and the team leader met demonstrated a good understanding of why it was important to have such good quality assurance systems in place regarding medication handling practises. All staff that are authorised to administer medication in the home have also refreshed their medication training and been reminded about their safe medication handling responsibilities. The team coordinator told us that none of the people who use the service are currently willing and capable of self medication. However, plans are being developed to suport one individual take greater responsibility for their medication, which is based on an assessment of risk contained in their care plan. Progress made to achieve this goal will be examined at the services next inspection. It was positively noted that in the three care plans examined in depth the wishes of the people who use the service about dying and death had been ascertained and recorded. Care Homes for Adults (18-65 years) Page 21 of 34 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 services arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. Insufficient numbers of staff are not suitably trained in recognising, preventing and reporting abuse, which needs to be rectified as a matter of urgency in order to keep the people who use the service safe. Evidence: The manager told us he had received one formal complaint about Lingfield Avenue since the last inspection. A record of the complaint and the outcome of the internal investigation undertaken by the providers was made available on request. The services complaints book showed us the concern had been taken seriously and dealt with in a very open and professional manner. The complaint was upheld and appropriate action taken to remained staff about their responsibilities as support workers. We spoken to the complainant who told us they were relatively satisfied with the outcome of the investigation and the action taken by them to minimise the likelihood of a similar incident reoccurring in the future. The manager told us relations with a local day centre have steadily improved in the past year, which the manager of the day centre also acknowledged. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: One individual who completed our survey told us they did not know who to speak to if they were not happy who how to make a complaint? The other response was more positive about the services arrangements for raising concerns, but they also added staff dont always take time to listen to them and they were unable to speak to their keyworker because they had been off sick for weeks. The manager demonstrated a good understanding of what constituted abuse and who should be notified immediately if abuse was witnessed or suspected. Records indicate that there have been no disclosures of abuse made within the service since it was last inspected or any staff refereed for possible inclusion on the Protection Of Vulnerable Adults register. Staff training records revealed that insufficient numbers of the current staff team had kept their safeguarding knowledge and skills up to date. The manager told us plans were in place for this training shortfall to be addressed in the next few months. The service is required to rectified this matter as soon as reasonably practicable. Care Homes for Adults (18-65 years) Page 23 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The property was suitable for its use but would benefit from some refurbishment, repair and redecoration. Evidence: The property is suited for its purpose. On arriving the expert by experience told us the front of the building was flat and accessible to wheelchair users. However, the house is old and some of the corridors are a bit narrow for large wheelchair users. In the main the property was bright, well lit, and comfortable. The home did not have a maintenance or refurbishment programme but the services regional and registered managers both assured us during the last day of this inspection that a budget had now been secured to replace the kitchen, replace a lot of the worm out soft furnishings, and to redecorate the entire interior. We recommend a time specific rolling programme for this proposed refit to take place is drawn up and sent to us. The providers are also required to replace the homes rather dilapidated kitchen within 6 months. The lounge was bright and adequately fitted. Like other areas of the home this room needed repainting. During a tour of the garden it was positively noted that as recommended in the services last report a covered gazebo had been erected to enable Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: people who use the service to take greater advantage of this outdoor space. One person who uses the service told us they liked the idea of having a covered space in the garden so they wouldnt get wet while enjoying a cigarette. Written feedback received about cleanliness in the home were mixed. One individual told us the home was always kept fresh and clean and that their - bedroom and clothes were always spotless. While another commented that there was - room for improvement in this area as the home was only kept fresh and clean sometimes. The expert by experience wrote in his report - I used one toilet and looked at the other toilet available on the ground floor. These were clean and fresh. Secondly I went around the living room, the dining room, the hallway and the shower room. The bedrooms are well decorated to the individuals taste and are clean and tidy. There is a lift to the first floor which is large enough for wheelchairs. These were well vacuumed and clean, although I felt that these areas could do with redecoration. Having activated a call bell alarm system in a ground floor toilet it was positively noted that two staff on duty at the time responded within seconds of it being set off. Staff were also observed responding promptly to call bell alarms being activated throughout the course of this two day inspection. Care Homes for Adults (18-65 years) Page 25 of 34 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 who use the service have safe and appropriate support as there are enough competent staff on duty at all times. However, the services arrangements for ensuring staff continually up date their existing knowledge and skills needs to be significantly improved. People using the service are safeguarded by sound recruitment procedures. Evidence: Written feedback received from surveys we sent out about staffing was in the main quite good. One individual who uses the service wrote staff always treated them well; while another told us this was usually the case. Both agreed that staff usually listened and acted upon what they said. All the members of staff who were on duty during the course of this two day inspection were observed interacting with a number of the people who use the service in a very caring, respectful, and professional manner. The expert by experience asked four people who use the service about staff. How are the attitudes of the staff when dealing with you? He wrote All the service users reported good experiences when dealing with staff. Do you feel you can express an opinion to the staff? He wrote All the service users said that the atmosphere was relaxed and they could express an opinion and have a joke with the staff. (I personally witnessed Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: some light hearted banter with the established staff which seemed relaxed and within acceptable boundaries). The team coordinator told staffing levels had recently been increased to ensure an additional four member of staff was now on duty to cover the morning shits, which are traditionally peak periods of activity. Staff met told us the services more flexible approach to planing the duty roster means its now much easier to meet the needs and wishes of the people who use the service. However, the manager conceded that in the past year the service had become over reliant on temporary agency suport workers to cover staff vacancies. Typical written comments we received from the people who use the service and their relatives about this matter, included - i would like to see more permanent Scope staff. Far too many agency workers that dont know the job. i dont like all these strangers, and there appears to be a lack of permanent staff. Too many agency staff who dont know the residents needs. i find it unsettling seeing so many different faces. People need continuity. It was therefore positively noted that the home had recently four new permanent members of staff in the past year and no longer had any permanent staff vacancies. The manager also told us the service no longer used agency staff, but a core team of Scope bank workers who were more familiar with the service users needs and preferences. Furthermore, as recommended in the services last report the manager had recruited a number of male suport workers to ensure the gender mix of the staff team reflected that of the people who used the service. The expert by experience asked the people who use the service about what they thought about the gender mix of the care team? He wrote All four service users said that they were happy with the mix of men and women that make up the staff. The manager is commended for redressing this former gender imbalance. Four staff files were examined in relation to the recruitment procedure. There was evidence staff had completed application forms and the format included a health declaration and provided details of referees which had been followed up prior to the person commencing employment with the provider. There was also evidence that POVA/CRB checks had been undertaken. All staff stated they had a contract of employment and a job description. The manager demonstrated a good understanding of what constitute good recruitment practise. 100 of our surveys returned to us by staff working at the home told us the training they received was relevant to their role, helped them meet the needs of the people who used the service, and kept them up to date with new ways of working. The training matrix introduced by the manager revealed a number of gaps in the current staff teams knowledge and skills. We recommend a time specific rolling programme is Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: established which sets out how the manger intends to address these staff training needs. As recommended in the services last report both the homes new team coordinators had now received training that gave then the necessary skills to carry out their managerial responsibilities. One team leader spoken with at length demonstrated a good understanding of her team coordinator responsibilities and was fully aware what her role was in the registered managers absence. As recommended in the services last inspection the manager was able to produce documentary evidence on request that showed his staff team were each receiving at least one formal supervision session with a suitably qualified senior member of staff every two months or so. Minutes of the last two meetings revealed they had both been well attended by staff and had covered a wide variety of relevant topics, including safe medication handling practises, staff training and time keeping. Care Homes for Adults (18-65 years) Page 28 of 34 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. The people who use the service benefit from living in a home that is now being well run by an experienced and competent manager. The services quality assurance systems have significantly improved in the past year and the home is commended for the way it ensures the views of the people who use the service and their representatives are taken into account when developing the home. Improvements made to the services fire safety arrangements ensures the welfare of the people who use the service, their guests, and staff are protected. Evidence: Roger Hughes has been operational day-to-day control of 11 Lingfield Avenue since August 2007. It was evident from the typical comments made by staff on duty at the time of this visit that the team like the leadership style of the registered manager. Typical comments from staff included, Rogers very approachable - you can talk to him Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: about anything, Roger seems to be around a lot more these days, and we are working much better a s a team as everyone is more aware what their specific roles and responsibilities are. The manager confirmed that he is indeed spending more time at Lingfield Avenue now that the other Scope service he is also responsible for are beginning to run down. Roger told us he usually spends most of the week at Lingfield on the early shifts. The expert by experience asked four people who use the service about management arrangements at Lingfield Avenue. Are there arrangements in place for people to speak to the manager if they are unhappy. The service users all said that the arrangements were either good or very good. What do they think of the deputies running the place in the managers absence. One service user said that things are much better than before. The other three expressed satisfaction with the new arrangements especially in the last year. The relationships in the home between the service users and providers seem very good. It has a good atmosphere. Documentary evidence in the form of a self assessment report undertaken by all the people who live and work at the home was produced on request. This comprehensive document identified all the areas the services major stakeholders felt needed to be improved and the report set out a time specific action plan top address any identified issues. The service is highly commended for carrying out such a through self audit. In addition to this the activity coordinator told us she had begun finding out what the people who use the service thought about the activities they were offered each month and was using this information to improve individual weekly activity schedules. As required in the service last two inspection reports regulation 26 visits undertaken by managers representing other Scope homes were now being carried out on a monthly basis and the outcome of these visits kept in the home. The homes fire records revealed that the fire alarm system continues to be tested on a weekly basis. As required in the service last report all the homes night staff had [participated in at least one fire drill 2009, which was carried out later one evening. Fire drills continue to be carried out at regular intervals during the day. Also as required in the last report the homes water heating had been tested for legionella in the past year. During a tour of the kitchen all the food kept in the fridge which had been taken out of its original packaging was being correctly stored in covered containers that were all labelled and dated in line with basic food hygiene standards. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 1 23 13 All staff that work at the service must continually refresh their safeguarding adults training. This will ensure staff have the necessary knowledge and skills to recognise, prevent and report abuse should they witness or suspect it happening within the home in order to keep the people who use the service safe from harm. The rather worn out and damaged kitchen must be repaired and/or replaced with new units within six months. This will ensure the people who use the service and staff live and work in a comfortable environment that is also fit for purpose of preparing large numbers of meals and drinks on a regular basis. 01/07/2009 2 24 23 01/10/2009 Care Homes for Adults (18-65 years) Page 32 of 34 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 7 The outcome of monthly one to one meetings people who use the service have with their designated keyworkers should be recorded. This will enable anyone authorised to view these minutes to determine whether or not the opinions of the people who use the service are being listened too, and taken seriously. People using the service should be offered far more opportunities to engage in more meaningful and stimulating activities in the wider community, especially day trips. This will ensure that the social interests and lifestyle expectations of the people who use the service are met. A record of the individualised programmes people who use the service are being actively encouraged and supported to follow in order to help them maintain and develop their independent living skills should be included in care plans. This will enable anyone authorised to inspect these records to determine whether or not staff are promoting the rights of the people who use the service to live their lives as independently as is reasonably practicable. The providers should establish a time specific rolling programme that makes it clear what areas of the property they plan to redecorate and what soft furnishings are going to be replaced. A copy of the programme should then be sent to us. These changes will ensure the people who use the service live in a more comfortable and homely environment. The manager should establish a time specific rolling programme which sets out clearly how he intends to address all his current staff teams training needs as identified in the homes training assessment. 2 12 3 16 4 24 5 35 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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