Care Home: Mayfair Avenue

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What the care home does well People are happy living at the home. People are able to choose what they want to do with their time. People are supported to learn new skills. The staff are happy working there and feel well supported. What has improved since the last inspection? People have tried new things and made personal achievements. Two new people have moved to the home and settled in well. The staff have undertaken different training to help them do their jobs better. The manager has listened to what we asked him to do at the last inspection and done these things. What the care home could do better: The manager talks to people who live at the home and staff and has plans to make improvements that they want. We have asked the manager to make sure some things are done slightly differently so that the service people get is even better and that they are kept safer. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mayfair Avenue 29 Mayfair Avenue Whitton Middlesex TW2 7JG 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: Sandy Patrick Date: 1 1 0 6 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 29 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 29 Information about the care home Name of care home: Address: Mayfair Avenue 29 Mayfair Avenue Whitton Middlesex TW2 7JG 02087155920 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) : mayfair@rhlt.org.uk Richmond Homes for Life Trust care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home Only (CRH - 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 The maximum number of service users who can be accommodated is: 4 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home 29 Mayfair Avenue is home to four people who have a learning disability. The home is owned and operated by Richmond Homes for Life Trust, a nonprofit making organisation providing residential and community-based services in the London Borough of Richmond. The weekly fees are £1, 020.34 The home is situated in a residential road in Whitton, within walking distance of community facilities and public transport networks. There is a Statement of Purpose, which provides good information about the home and includes the aims and objectives of the service. Care Homes for Adults (18-65 years) Page 5 of 29 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 Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home The inspection included an unannounced visit to the home on 11 June 2009. We met three of the people who live at the home, staff on duty and the manager. We looked at records, the environment and how people are cared for and supported. We wrote to the manager and asked him to complete a quality self assessment. We wrote to the people who live at the home, their representatives and staff and asked them to complete surveys about their experiences. We looked at all the information we had received about the home since the last key inspection. Some of the things people told us about Mayfair Avenue were The residents come first and that is how it should be. The Trust is the best service I have ever known. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well What has got better from the last inspection People have tried new things and made personal achievements. Two new people have moved to the home and settled in well. The staff have undertaken different training to help them do their jobs better. The manager has listened to what we asked him to do at the last inspection and done these things. Care Homes for Adults (18-65 years) Page 8 of 29 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sandy Patrick 33 Greycoat Street London SW1P 2QF 02079792000 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. Care Homes for Adults (18-65 years) Page 9 of 29 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 29 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 29 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 are given the information they need to help them decide if they want to live at the home. There are opportunities for the staff to assess their needs to make sure the home is the right place for them. Evidence: Since the last inspection 2 new people have moved to the home. We met both of these people. They had visited and spent time there before making a decision to move to the home. This included an over night stay. These visits gave people the opportunity to find out if they wanted to live there and also gave the staff the opportunity to assess their needs and decide if Mayfair Avenue was the right place for them. One person told us, a series of visits were arranged including meals and then an over night stay. The organisation makes assessments of each persons needs by speaking to them, their representatives and other important people in their lives, like the staff who have worked with them previously. Both the people who have recently moved to the home already knew the other people living there and some of the staff. This made the transition easier for them. They now Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: feel settled and happy at the home. The organisation have produced a guide which tells people what services they can expect and are entitled to. People who live at the home told us that they had enough information to help them make a decision about moving there. Care Homes for Adults (18-65 years) Page 13 of 29 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 . People are given the support they need to make choices about their lives. The staff know how to give people this support because information is clearly and accurately recorded. Evidence: People who live at the home have their needs, wishes, strengths and skills recorded in care plans and guidelines for staff. These records help the staff to understand what they need to do to give people the support they need. We looked at some of these records. They were very clear and used photographs and pictures to help the people they are about to understand them. One person told us, choices are given, my relative indicates non verbally what they want to do and the carers understand and try to follow their wishes. One member of staff said, our service puts the needs of service users first and gives them the opportunity to enrich their lives, we take everyones individuality into account. Another member of staff told us, the Trust always puts the needs of the residents first and works in a person centred way. The Trusts listens to the residents and staff. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: The staff have made assessments of the risks people face. These show how people can be supported to do different things without endangering themselves or others. The staff had not made recorded risk assessments for the two newest members of the house hold. They should think about any risks these people face and also any restrictions the staff make on them and these should be assessed and recorded. People who live at the home are able to make decisions about their lives, the things they do and what happens in the home. The staff support people to make decisions each day about what they wear, eat and how they spend their time. We saw that the staff gave people clear information to help them make decisions. Care Homes for Adults (18-65 years) Page 15 of 29 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 . People are supported to learn and develop skills so that they can live the lives they choose and have control of what they do. They are able to decide how they want to spend their time and are supported to stay in touch with friends and family and to be a part of the local community. Evidence: People who live at the home are supported to learn a range of skills which help them to live their lives. The staff support people to understand about healthy eating, shopping, cooking, household chores and using the community safely. Each person has a different plan which records the support they need and the skills that they would like to learn and develop. The manager told us that the staff planned to get people even more involved in activities at the home, so that they can try new things and have more control over their own lives. People told us that they were given the help they needed to do the things they wanted to do. One member of staff told us, the service gives the best possible support to service users to help them live an independent life. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Recently, the resource centre where people spent some of their time closed. This meant that the staff needed to help people think of things to do throughout the day, every day. Through discussions with each person they have created a weekly plan for each individual of things to do that they enjoy. We saw that everyone had their own planned activities and free time and these included using local facilities, being parts of groups, doing activities on their own and learning new skills. Some people are being supported to do things that they have not had the opportunity to do before and this is really positive for them. People are supported to stay in touch with friends and family. Some family members visit the home, and the people who live there have hosted parties, meals and other events to help them stay in touch. Visitors told us that they were made welcome at the home and that they were well informed about things they needed to know. A member of staff said, we are always talking to families and keeping them involved. People who live at the home are involved in shopping for food, preparing meals and planning menus. We saw the staff giving people choices about what they ate during lunch on the day of our visit. We saw that people are supported to have a healthy diet. The kitchen was stocked with fresh food and fruit. All meals are prepared freshly each day. People told us that they liked the food they had. Care Homes for Adults (18-65 years) Page 17 of 29 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 . People are supported to stay healthy, clean and fresh. They are given support to make sure they have the right medication to meet their needs. Evidence: Personal care and health needs are recorded in peoples individual plans. We saw evidence that the staff supported people to keep clean and fresh. Everyone is registered with a local GP and other health care professionals as needed. We saw that consultations with health care professionals are recorded and that recommendations and guidelines they make are used to help plan the care and support the staff give each person. The staff help people to take their medication. There are appropriate procedures for this and all medication is safely stored. We saw that the staff made accurate records to show when medication had been given to someone. We found one box of tablets that did not have someones name written on. We could see that this belonged to a specific person because they had another box of the same tablets and no one else did. However, the staff need to make sure all medication is labelled with the persons name as this will reduce the risk of something going wrong. The staff record the amount of medication they receive from the pharmacy and the date of this. This is important do Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: that checks can be made to make sure people are receiving the right medication. We found that the amount of medication for one person was not recorded and this could mean that errors might happen and no one would know. Therefore the staff should make sure they always record the amount of medication received into the home. Care Homes for Adults (18-65 years) Page 19 of 29 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 . People who live at the home are protected by procedures and know that they are able to make a complaint if they are unhappy with anything. Evidence: There is a complaints procedure and everyone has been given a copy of this. People told us that they knew what to do if they had any concerns. There have been no formal complaints since the last inspection. The organisation has its own procedures on protection of vulnerable adults and whistle blowing. The home also has a copy of the local authority procedure on safeguarding. The staff have all had training in this. The staff who contacted us indicated that they knew what to do if they were worried about anyones safety. The staff look after the money of people who live at the home. They support them to access their bank accounts and to spend their money on the things that they want to. We looked at records relating to peoples money and saw that these were accurate and all transactions and expenditure were recorded. Care Homes for Adults (18-65 years) Page 20 of 29 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 live in a pleasant, attractive and homely environment, where they are free to express themselves and personalise as they wish. Evidence: The home is attractively decorated and has been personalised by the people who live there. Everyone has their own room. We saw some of these and saw that people had chosen their own furniture, colour schemes and personal belongings. There is a lounge and a separate conservatory. The kitchen has space for dining. There is a garden. The environment is well maintained and redecorated as needed. The home was clean and fresh throughout our visit and the manager told us that staff cleaned and laundered towels and linen daily. Care Homes for Adults (18-65 years) Page 21 of 29 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 are cared for by well supported, trained and appropriately recruited staff. Evidence: The home employs sufficient staff to meet the needs of the people who live there. The staff team have worked at the home for some time and know everyones needs well. There is good information for the staff on their roles and responsibilities. The manager and other senior managers in the organisation interview potential staff. They make checks on their suitability including references and criminal record checks. New staff have to complete induction training and a workbook which shows their skills and knowledge. The manager appraises new staff on their abilities and suitability to the role. We looked at a sample of staff records and saw that all recruitment checks and required information were in place. The staff are supported to undertake a range of training. We saw that all the staff had up to date training in key areas and learning opportunities in other areas to develop their knowledge. Staff are supported to undertake NVQs. We saw evidence of staff training. One member of staff told us, training is always on going. Another member of staff said, training is always offered and has helped me do my job better. The staff team work well together and have monthly meetings. We saw minutes of Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: these and saw that important issues and each person who lives at the home were discussed. We saw that there were good systems for communication and support and that the staff used these well. The staff who contacted us said that they felt well supported. One member of staff said, we work well as a team, giving and receiving good support to and from our manager. The manager meets with staff individually to offer them formal support and supervision. We saw that sometimes these planned meetings did not take place. Although the staff feel there is good informal and team support, they do need opportunities for regular planned meetings with the manager to discuss their own work performance and any issues. Care Homes for Adults (18-65 years) Page 23 of 29 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 live in a service which is well managed. There are systems for monitoring the quality of service people receive and plans for future development. People are kept safe through regular checks and good health and safety practices. Evidence: The manager has been in post for over three years. Before this he worked in another of the organisations homes. He has an excellent knowledge of the people living at the home and their needs and he demonstrated this in his discussions with us. He has supported individual people, staff and the service to make changes and develop. He has ideas for the future and how he would like people to be supported as further changes take place. People who contacted us said that they found the management approach open and positive and that they were able to contribute their ideas and opinions. One member of staff told us, the manager gives the best care and support to service users and cares about the staff lots a well. Records at the home are up to date, accurate and clear. Information is easy to access Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: and see. The area manager visits the home regularly and make checks on the quality of the service. The manager asks people who live at the home and staff for their views on the service. Peoples care plans are regularly reviewed. There are recorded checks on health and safety, including fire safety. We saw that where health and safety hazards had been identified these had been addressed. We saw that the homes fire risk assessment gave an overview of the environmental factors, but did not incorporate other risks. During a recent fire drill some of the people living at the home refused to take action. The fire risk assessment should also consider the risks that everyone faces if anyone did not take appropriate action in a real fire situation. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes  No  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 26 of 29 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 Description 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 Description Timescale for action 1 9 13 The registered person must make sure assessments of risk are made and recorded for any risks people may experience and any restrictions that are placed on people because of these risks. 31/07/2009 Because people need to be kept safe, but the staff should not make a judgement about how to keep people safe unless they have assessed the risks they face. These assessments need to be recorded as evidence of a thorough assessment. 2 20 13 The registered person must make sure all medication is correctly labeled and the amount of this is correctly recorded. 30/06/2009 Care Homes for Adults (18-65 years) Page 27 of 29 Because people may be put at risk if medication is not well managed. 3 35 18 The registered person must make sure each member of staff has regular, formal, planned supervision meetings with the manager. 31/07/2009 Because the staff need to have a formal structure of support and the manager needs to have a system where each staff members performance can be appraised and discussed regularly. 4 42 13 The registered person must create a detailed fire risk assessment for the home and keep this under review. This assessment must be shared with all staff. 31/07/2009 Because the staff need to have a plan of what to do in event of a fire or risk of fire which is based on an up to date assessment of all potential risks, not just environmental ones. 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 Care Homes for Adults (18-65 years) Page 28 of 29 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. 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. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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