Care Home: Sidney Avenue Lodge

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What the care home does well Even though there is no registered manager, the home is running well with the close involvement of the owners and their family. The residents feel that they live in a safe, friendly and comfortable home. The staff are accessible and the residents can talk to them if they have a concern. The activities arranged for the residents have enabled them to be engaged by going out and attending day centres or places of work. The residents` medical needs are met by a good system of monitoring health care needs by supporting them to attend their appointments. What has improved since the last inspection? This is the first inspection of the home since its re-registration. What the care home could do better: There is a need for the home to ensure that needs assessments, care plans and risk assessments are updated with the involvement of the people who use the service and, as required, with their representatives. This ensures that the residents` new needs are identified and met with revised care plans. The residents must be supported to access their money and must not rely on the company`s money which is lent to them. This enables the residents to be more independent and to obtain things they like with their own money. It is important for the owner of the home to ensure that the certificate of registration reflects the details (including name) of the responsible individual. This will help clarify who is responsible for the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Sidney Avenue Lodge 24 Sidney Avenue London London N13 4UY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Teferi Degeneh     Date: 2 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Sidney Avenue Lodge 24 Sidney Avenue London London N13 4UY 02088891429 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Greenfields Residential Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category 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 Date of last inspection Brief description of the care home Sidney Avenue Lodge is a care home owned by Greenfields Residential Care Homes Limited and registered to accommodate eight adults, who have a learning disability. The home is situated on a residential street, off Green Lanes, between Palmers Green and Wood Green. The home is within easy walking distance of local amenities and buses. There are four single bedrooms and two shared bedrooms. Residents share a lounge, dining room and garden along with a bathroom, shower room and two further Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 8 Brief description of the care home toilets. Currently there is one vacancy with seven people who use the service living at the home. All the present residents are men. The weekly fees depend on the assessed needs of the people who use the service but range from £336 to £623. More information about the home including a copy of the inspection report can be obtained by requesting directly from the home or through the CQC website. Care Homes for Adults (18-65 years) Page 5 of 25 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 home had not been informed that we were visiting to undertake inspection. When we arrived at 8 am the person in charge and a care worker were already at the home. The person in charge, who was also one of the owners (the other being his wife) and an acting manager, was present throughout the inspection. Before our visit to do this inspection, we had received a self assessment form known as the annual quality assurance assessment (AQAA) from the home. An AQAA is a form which we request from care homes every year to complete and send back to us. It gives care homes an opportunity to tell us how they are planning to improve the service. We had a look at the AQAA as part of this inspection. We had also received survey forms completed by all the seven people who use the service and four members of the staff. We checked these surveys. The other activities we carried out on the day of this inspection included a tour of the Care Homes for Adults (18-65 years) Page 6 of 25 building, the examination of the residents files including care records, the examination of health and safety records, the viewing of staff rotas and discussions with and observation of people who use the service, care staff and the homes management. We have also considered all the other information that we have about the home. Care Homes for Adults (18-65 years) Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 25 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 9 of 25 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. New residents are confident that the home has a procedure of admission which which identifies their needs and which ensures that there are good facilities and services for them to use. Evidence: The owner of the home said no new residents have been admitted since the home was re-registered in October. He said all the seven residents have lived at the home for many years. We observed and spoke to five of the people who use the service. One person said they have lived at the home for fifteen years and they liked it. Another resident said they have been here for over four years and they like the home and the other residents. The person in charge explained the process of admission. He said if new residents are referred to the home, either himself or a senior member of staff visits them and completes their assessment. He said the home admits only if the residents are happy with the service and if their needs can be met. We checked five residents files. All these files contained assessments and care plans. Care Homes for Adults (18-65 years) Page 10 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Even though the residents are satisfied with the care they receive, they are not sure if and when their needs are reviewed and new care plans are developed for them. This does not make the resident to be confident that their needs are always fully met. Evidence: All the five files we checked contained evidence of care plans even though some of them have not been reviewed for more than a year. The person in charge explained the reasons for this by saying that the new owners have not had sufficient time to organise reviews and new care plans for all of the residents by contacting their families and social workers. He said the home is in the process of setting up reviews for all the residents. Three of the five files we checked had up to date care plans and risk assessments for the residents. We observed the residents talking freely to the staff and to the owner about their needs and about the home. Many of the residents are able to travel independently to day centres or places of work. It was evident from discussions with and observations of the residents that they all get on well. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: We noticed in the incident book that a resident had choked and we followed this up by talking to the person in charge and checking a risk assessment. We were satisfied with the first aid given and action taken to call emergency service to help the person involved in the incident. The examination of the files also confirmed that the home has implemented relevant risk assessment for the service user to reduce the risk of choking. Significant residents daily events and activities are recorded by the staff for each resident and kept in their files. There is also a system of keeping monthly summaries for each resident. These are useful because they readily show what a resident has done during the day or month. Care Homes for Adults (18-65 years) Page 12 of 25 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. There are good arrangements for the residents to be occupied which means that they are engaged. The meals provided at the home are good and the residents special dietary needs are met. Evidence: When we arrived at the home at 8 am, most of the residents were already up and were having their breakfast. Five residents whom we talked to said they regularly go out to a day centre or a place of work. Most of the residents can travel independently by taking public transport. The person in charge said the home supports two service users who do not independently travel. The residents files contained details of activities and training available to them. From discussions with the staff and the residents we understand that the residents are involved in household chores such as preparing meals which would enable them to be as independent as possible. We observed some residents preparing their breakfast independently. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: From discussions with the person in charge and the residents, and from the visitors book it was clear that many residents were visited by their families. We saw some residents going out for a walk or to local shops and returning. There are two lounges where the residents can sit together to socialise or watch television programmes. The person in charge said families and friends of the residents can visit and the the home has a plan to organise barbecue to which the residents friends would be invited. A holiday was also being planned for the residents. We noted from discussions with the residents and observations that the residents have access to all communal areas such as the lounges, kitchen, dining area, bathrooms. Each resident has their own television set in bedrooms. The residents are all registered on the electoral roll and have obtained their voting cards. The residents we talked to told us that they are happy with the meals. They also confirmed in a survey form they completed that they liked the meals. The person in charge confirmed that the residents can choose what they eat. He said that the menus are flexible with the residents being able to choose what they eat daily or as they wish. Records in the residents files and discussions with the person in charge indicated that the home ensures healthy eating as well as the residents cultural, belief and medical situations. From a discussion with the person in charge we noted that all residents have bank accounts to which their benefits are paid. However, the person in charge said, the residents have not been able to cash their money due to the closure and transfer of the bank from a nearby branch to another one which is a bit farther. He said as there are no banks nearer the home he is planning to discuss with people concerned the best way of supporting the residents to cash their money. He said, at the moment the residents are paid from the homes budget. He said he keeps records of the money paid to the residents so that they will be able to pay back when they take out their money from their own bank accounts. This needs to be reviewed by the person in charge. Care Homes for Adults (18-65 years) Page 14 of 25 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. There are good systems and experienced staff to meet the health and personal care needs of the people who use the service. The residents feel supported with respect and dignity. Evidence: On the day of this inspection all the residents we saw looked relaxed and were well presented. From the residents files and from discussion with the person in charge it was clear that the residents health care needs have been met. The person in charge confirmed that all the residents had dental and eye checks. He said all the residents are regularly seen by their consultant psychiatrists and they are also registered with their own general practitioners. At the time of this inspection one resident was reported to be not feeling well and was in a hospital receiving treatment. The care workers we observed and talked to appeared to have a caring attitude to the residents. We saw good communication and interaction between staff and residents. In the survey forms they completed and during our conversations with them, the residents confirmed that they are happy with the staff and that the staff treat them with respect and dignity. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: Medication is administered by the staff. Many of the staff have worked at the home for many years and had training and experience to safely administer medication. No new staff have been employed except some members of the new owners family. The person in charge, who is also part owner of the home with his wife, said that all staff are trained and experienced. We checked medicines and medication administration records which were all in order. The person in charge said he is in the process of changing the current system of receiving medicines in manufacturers packets to to obtaining them in dossette boxes. Medicines are kept in a locked cabinet in the office. Care Homes for Adults (18-65 years) Page 16 of 25 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 people who use the service are confident that they can make a complaint and that their concerns are dealt with by the home. Evidence: No complaints have been recorded since the home was re-registered. There is a complaints procedure which is also displayed in the dining room. The residents who completed the form confirmed that they know who to talk to if they have a complaint. The home has a policy entitled abuse, which describes what abuse means and how to safeguard the residents. Two members of staff we talked to were able to give a satisfactory explanation of what abuse means and what the home needs to do to ensure that the people who use the service are safeguarded. We were concerned that the home did not have a copy of the local authoritys relevant policy on safeguarding adults. During our conversation and in a subsequent email they sent us, the home confirmed that they have contacted the local authority for a copy of their policy on adult protection. Care Homes for Adults (18-65 years) Page 17 of 25 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. The location and the facilities of the home are good. This has enabled the residents to feel safe and live comfortably. Evidence: All parts of the home such as the kitchen, dining room, lounges, and the two bedrooms we saw were clean and without a bad smell. The person in charge said they have found out after taking over the service that the home had many areas that needed work such as replacing the bath on the ground floor, radiators and the kitchen. We saw that the bathroom on the ground floor was still not in working order; however, we were informed by the person in charge that an arrangement had been made to fix the bathroom. Two days after the inspection we were informed by email that the work in the downstairs bathroom was completed and the residents had started using it. Two of the bedrooms are shared by four residents and there are other four single bedrooms. Currently one room is vacant as there are only seven residents at the home. From a conversation with two residents who shared a bedroom it was confirmed that they did not mind sharing the bedroom and in fact they got on well. As mentioned above there are two lounges each with a television set and sofas for the Care Homes for Adults (18-65 years) Page 18 of 25 Evidence: residents to sit and socialise or talk. The residents have lived at the home for many years and all those spoken with said they liked the home. The home is situated in a residential area close to local shops and cafes. There is a partly paved large garden at the back of the home. This is an area where the residents can relax and enjoy barbecues when the weather allows them. At the time of our visit the garden was in need of looking after by, for example, cutting the grass and planting flowers, herbs or vegetable which may benefit the residents. We were informed by email and telephone that the grass had been cut and the home was preparing to plant some flowers and vegetables in the garden. Care Homes for Adults (18-65 years) Page 19 of 25 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. The residents are confident that they are supported by committed and experienced staff. This ensures their safety and wellbeing. Evidence: The staff rota was checked and showed that there are usually two care staff on shift during early and late shifts. The night shift is covered by a waking night staff. Most of the residents are not at the home during the day because they go to their activities. The home has not employed new care staff outside of some members of the owners own family. The existing members of staff have a national vocational qualification (NVQ) level 2 or 3 in care. As mentioned above the staff we observed and spoke to were able to demonstrate their good knowledge of supporting the residents with respect and dignity. The person in charge said he has a plan to provide training in safeguarding, medication and other areas for all staff. The residents confirmed through conversations and survey forms that they are happy with the staff. We checked five staff files and all contained evidence of criminal record bureau checks and two written references. There is also evidence of contracts and terms and conditions of employment in the files we checked. Care Homes for Adults (18-65 years) Page 20 of 25 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. There is good management structure to ensure that good quality service is provided in a safe environmet. Evidence: The person in charge said he and his wife had bought the company from the previous owner. However, the certificate of registration held on the file showed the name of the previous owner and manager as the responsible individual. This needs to be followed up by the current owner and amended. The person in charge said he had worked as a care worker for many years. He said he had completed NVQ level 2 and 3 in care and has embarked on NVQ level 4 in leadership and management of care services. He said he had previously studied law. We found the person in charge to be co-operative and willing to improve the quality of care. The residents we observed and talked to were happy with the management of the home and the services they received. A deputy manager and another care worker assist the person in charge with management and administration of the service. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: Seven incidents and accidents have been recorded since the re-registration of the home. All these, including the choke incident mentioned earlier, have been managed well. From health and safety records it was evident that fire drills and fire alarm checks have been undertaken recorded regularly. New radiators have been recently installed and the gas boiler was checked on 24/02/2010. Conversations with the person in charge indicated that a formal quality assurance system in which the residents and their representatives are asked about the quality of the service is currently being planned. Each service user has a key worker who has a special interest in their care and who listens to them. The residents also have meetings in which they talk about common issues that they feel need improvement. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 6 5 Regular needs assessment 31/08/2010 reviews and care plans must be undertaken for the residents. This ensures that the residents needs are identified and met. 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 13 The people who use the service should be supported to access their money rather than relying on money from the home. In this way the residents will feel confident and be able to spend their own money. The garden should be looked after in order to allow the residents to make maximum use of it. The certificate of registration should be amended to reflect correct details of the responsible individual. This will clarify who is responsible for the service. 2 3 28 37 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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