Care Home: Tavistock Avenue (5).

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What the care home does well This small home provides a very individualized caring service where people can live in a homely and safe environment..The staff are good at listening to people to find out what they want. The people who live in the home like the staff and the staff like them. They understand what each person is saying.People in the home help write their own care plans. The staff meet with people often to check that their care plans are okStaff do the right things to keep people healthy. They make sure people see the doctor or go to the hospital if they are ill. What has improved since the last inspection? Staff check with the people who use the service that their care plans contain all the required information including risk assessments and that these are written in a person centered way.The home has made lots of improvements to the decorations and furnishings in the lounge and bedrooms. It is planned to have a new television and to refurbish the kitchen. What the care home could do better: The home should make changes to some aspects of the system of storage and administration of medication to ensure that this is done safely. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tavistock Avenue (5) 5 Tavistock Avenue St Albans Hertfordshire AL1 2NQ two star good service The quality rating for this care home is: 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: Jan Sheppard Date: 1 3 0 5 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 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Tavistock Avenue (5) 5 Tavistock Avenue St Albans Hertfordshire AL1 2NQ 01727843545 01727843545FP 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) : Cherry Tree Housing Association care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: Date of last inspection A bit about the care home The home is a two storey semi-detached house in a residential area of St. Albans. It is owned by Cherry Tree Housing Association and is situated close to the city centre with easy access to public transport. The ground floor comprises a lounge, a combined kitchen dining room, one bedroom, an assisted shower room and a laundry room. Two bedrooms, a bathroom and a staff office are located on the first floor. The home provides full care services in a safe and homely environment for three service users who all have learning disabilities. The current fee for the residents who are all sponsored by Hertfordshire County Council is £916 per week. Recent CQC inspection reports are available in the home for residents and visitors to read. Information regarding the service is available in the Statement of Purpose and Service User Guide. 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 How we did our inspection: This is what the inspector did when they were at the care home The report is written using accumulated evidence gathered prior to the inspection including information contained in the AQAA ( Annual Quality Assurance Assessment) completed by the manager, information given in any pre inspection questionnaires and also takes account of statutory notifications sent periodically to the CQC by the home. We made a tour of the building. We had in depth discussions with the homes manager and spoke with all the service users and with all the staff on duty. Spot checks were made on a number of the homes records and care plans. What the care home does well This small home provides a very individualized caring service where people can live in a homely and safe environment. . The staff are good at listening to people to find out what they want. The people who live in the home like the staff and the staff like them. They understand what each person is saying. People in the home help write their own care plans. The staff meet with people often to check that their care plans are ok Staff do the right things to keep people healthy. They make sure people see the doctor or go to the hospital if they are ill. What has got better from the last inspection Staff check with the people who use the service that their care plans contain all the required information including risk assessments and that these are written in a person centered way. The home has made lots of improvements to the decorations and furnishings in the lounge and bedrooms. It is planned to have a new television and to refurbish the kitchen. 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 Jan Sheppard CQC CPCI 1 Capital Park Fulbourn Cambridge 01223 771330 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 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 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 plan to move in to the home are involved in the choice of the home and in the assessment process. Staff have the knowledge and experience to meet each persons care needs. Evidence: One new resident has moved into the home since the last inspection and they have now lived there for several months and are very well settled. The home has a process of assessment before anyone moves in and the care plans are written with information and procedures drawn from these assessments. The manager and another member of staff visited the applicant at their home having first had the benefit of a full needs assessment compiled by a social worker. The applicant and relatives were then invited to visit the home view the accommodation and meet with the other residents. The applicant made several visits and stayed for a meal at the home before moving in. The care plan was discussed with them and evidence of this could be seen by their signature on the plan. The home has all the required information about the service Statement of Purpose and Service Users Guide, and these along with a Tenancy Contract are present on each persons file. Since the last inspection the home has made progress with adding easy read picture illustrations to much of the homes documentation this to enable better understanding for the people who use the service. 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 promotes their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff has 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 who live in the home can be confident that they will be fully involved in all the decisions about their lives in the home and that the staff will be proactive in ensuring that each person is supported to make their own views known. Evidence: Since the last inspection the care plans have all been viewed and are presented following a person centered format which the manager said that they hoped to further improve upon. These plans cover needs associated with personal care, health, social and leisure needs as well as needs around equalities and diversity issues such as disability, culture and religion. The files of all three residents were looked at and it was seen that these were maintained up to date with clear detail of the care required and how this should best be provided to meet their individual likes and preferences. The involvement of the resident in the compiling and review of these plans was evidenced by their signing them. The focus of the care plan was to support each resident to be as independent as possible and where possible to improve their skills for independent living. Long term and short tem goals were identified and a regular, usually monthly, review process could be evidenced. Each person is given as much opportunity as possible to make their own decisions where ever they can. Staff spoken with confirmed they found the care plans to be clear and up to date and that they always felt that they knew the goals that they should be working towards with each individual resident. One said that up to date information about the people we support and their changing needs are discussed in meetings and in supervision. Risk assessments could be seen on each care plan which gives guidance to staff in supporting the residents to take risks as part of an independent lifestyle. These risks had been individually assessed and were linked to the plans and goals for each person. Evidence: For example for the person who goes unaccompanied to the local shop to buy magazines the risk had recently been reassessed by means of a worker accompanying them on the visit and for good practice had explained the situation to the local shop keeper who knows them well. The care plans evidenced that the people who use the service have prompt access to medical services whenever these are needed and it could be seen from the care plan records that the home works closely with social services and with the day centre staff. 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 supports 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 people who live in the home are supported to live full and active lifestyles which meet their needs and expectations, and they are supported to maintain relationships with people important to them. Evidence: All the people who live in the home have an individually planned day activities programme which has been designed to meet their interests and abilities. Activities for two people cover selected weekdays and some evenings and regular time at weekends. They attend a variety of local day centers and clubs where they participate in a range of practical activities and life skills classes. These activities include horticulture at the Earthworks Project, visits to a Gym and the local Swimming Pool and for one working in the kitchen at a local cafe. Outings into the local town with a friend from another nearby home are also regularly made by one resident. One person who declines to attend local centers has a home based outing and activities programme organized by staff who know them well. Their needs and wishes are being kept under review and appropriate medical support is being given. All the service users have family or friends and they are assisted by the staff to maintain contact with them and to make staying visits to them if they wish. The staff also regularly takes them out into the local community for a variety of leisure and entertainment activities and the home has planned a number of outings to local places of interest over the summer months. A day trip to Brighton was being discussed and photographic evidence could be seen of recent visits to Knebworth Park and to a theatre show. Group meals out in local restaurants are popular and the home will often arrange these occasions in Evidence: conjunction with residents from their other home which is nearby. The people who use the service told us that they were looking at holiday brochures and planning a holiday for later in the summer. Staff confirmed that if they wish it a staying away holiday is taken every year either for long weekends or for a continuous week. All the people who use the service are involved with the weekly choice of menu and the purchase and preparation of the food and in talking with them it was clear that they had a good awareness of the benefits of eating healthily. Good variety and daily choices are available and it was heard during this visit that residents are asked what they would like to have for their evening meal. The menu for this evening is X is that alright for you or would you like something different? one service user was asked .The home follows a healthy eating plan and low fat yogurts and fresh fruit were seen to be freely available for the people who use the service to help themselves to. Records of the meals actually consumed along with regular weights are kept and it is to be commended that people using the service have reduced or stabilized their weight since the last inspection. 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 follows. 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 . The home is proactive in addressing the health and personal care needs of people who use the service according to their individually assessed needs and they are treated with respect and dignity. The staff are experienced and trained so that they are able to provide a good quality of care for the people who live in the home and to ensure that their individual needs, choices and preferences are met at all times. Some aspects of the homes medication procedures need to be improved to ensure full safety for the people who use the service. Evidence: During this inspection it was seen that the people who use the service were being supported by staff in a very kind and respectful manner which addressed their individual needs and preferences. Staff were seen to knock on bedroom doors before entering and to invite people to make their choices known; would you like to have some tea in the kitchen or take it in your room? was one choice heard? People who live at the home told us that they were well cared for and throughout the visit they appeared to have an easy and relaxed relationship with the staff. One service user told us I like staff x they will always talk to me. Comments from one of the relatives echoed this Staff go out of their way to help my relative’, they said. The care plans were found to give good detail as to the individual care needs and how these should be met. Plans were seen to be maintained up to date to be regularly reviewed and to have appropriate risk assessments in place. A record of all health checks, actions taken and any resulting outcomes were seen to be recorded. References to hospital visits, contact with GPs and other health professionals evidenced that staff are pro active in addressing any possible health concerns and the Manager explained that since the last inspection specialist health care had been given to the staff group also to ensure that they had the necessary skills and support to deliver the required support Evidence: to meet the special needs of the people who use the service. The appropriate level of personal support is offered or appropriate prompting given to ensure that physical needs are met but support is not given in a manner which detract from the persons their ability to carry these tasks out for themselves if and when they are able. The level at which personal support is provided and the physical and emotional needs of the people using the service met was seen to be high with staff giving particular attention to detail and to the changing level of needs of the service users. One person said I get on well with the staff I like X particularly she is my friend and she helps me. The home has systems in place to manage people’s medication and a sample of the medication records checked found that these were fee from errors with no signature gaps found on the MAR (medication administration record) charts. All the staff who administer medication have been trained to do so and seemed confident with this task. Medication is supplied in individual boxes and the date of opening the box is written on it. However it was found that some medication is being double dispensed which is an unsafe practice and must not continue. The home does not have a controlled medication cupboard and administration register which could also place the people who use the service at risk as such medication may easily be suddenly prescribed at which point the home would not be able to store it in the required safe conditions. To date the home has never had any controlled medication prescribed but the manager acknowledged that this could easily and unexpectedly happen. The manager discussed with us the benefits of changing to a MDS (monitored dosage) bubble system for the medication and agreed that she would discuss this with a local supplier. Subsequently the manager has informed us that the home is to adopt this bubble system and that staff will be attending training concerning this shortly. 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 live in the home are encouraged and enabled to make their views and concerns known. Appropriate procedures are in place to ensure that they are protected from abuse and neglect. Evidence: There have been no incidents concerning Adult protection (Safeguarding) since the last inspection. Staff spoken with had a sound understanding of this subject and were clear when an incident needed to be referred to the local authority as part of the local safe guarding procedures. The records evidenced that all the staff had undertaken safeguarding training and that since the last inspection refresher training on this subject had been undertaken along with staff from the Associations other home which had included training about how to support people who have to give evidence in court. Staff spoken with evidenced their awareness of their extra responsibilities in this area and their need for vigilance and close observation of any signs exhibited by the people who use the service given their limited verbal ability. No complaints have been made to the home or received by the Commission since the last inspection. The complaints policy is clearly stated and also presented in a visual format. The procedure has been explained to all the service users who also have a copy given to them to keep in their rooms. 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 physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment that encourages independence. Evidence: Number 5 Tavistock Avenue is an ordinary semi detached house in a quiet residential road on the outskirts of St. Albans. The building is small and homely and has over the years been suitably adapted to meet the needs of its three residents so that it now provides a comfortable and safe environment which encourages their independence. On the day of this unannounced inspection the home was found to be very clean and tidy. All the residents have single bedrooms which are well furnished with furniture and fittings that reflect their own interests and tastes. Since the last inspection one bedroom has been redecorated and staff have helped another of the service users to reorganize the storage of their possessions. They told us that they were very happy with the new appearance of their room. New decorations and furnishings have been completed in the lounge which now has a fresh modern and comfortable appearance. The exterior of the property has been redecorated and works to remove overgrown trees in the garden have greatly improved this area and has given a better outdoor space for the service users where they all enjoy having Bar B Qs. Other works of refurbishment completed since the last inspection have included the covering of radiators the fitting of fire door guards and further works of redecoration in the communal areas of the home. Staff and service users told us of the plans that the home has to refurbish the kitchen and to provide a dishwasher and a digital television. The manager spoke also of her wish to move the clothes dryer away from the kitchen into the laundry area of the home. All these plans evidenced that the home has an on going programme for maintenance and refurbishment. 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 the staff get the right training, supervision and support they need from their manage 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 people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs and are well supported to do this. Evidence: The home is fortunate in retaining a very stable group of experienced and qualified staff. Two staff changes which have occurred since the last inspection have been necessitated by ill health retirement and because of a move from the area. The two new staff either already have or are studying for NVQ 2 and checks made on their recruitment process evidenced that all the required checks had been made to ensure safety for the people who use the service. The records evidenced that staff receive regular supervision and an annual appraisal. All the staff spoken with said that they were very happy working at the home and that they were well supported by the managers at all times. The staff records showed that training continues to be given a high priority in the home with courses on fire safety, medication, understanding mental health issues within learning disability, first aid, working with depression, the Mental Capacity Act and Deprivation of Liberty having been undertaken since the last inspection. One senior support worker has recently completed two day training on staff management and supervision. All staff has undertaken Safeguarding refresher training and a Food Hygiene course is planned for July 2009. Staff confirmed that they continue to have good training opportunities despite holding a professional qualification and that they value the way in which to maximize there effectiveness training courses are discussed by the team at their regular staff meetings. 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 home is well managed and the management actively seeks the views of the residents and other people involved to ensure that a good quality of care is provided. Evidence: The manager has the required qualifications, (NVQ level4 Registered Managers Award), and experience and is competent to run the home. Since the last inspection she has been registered by the Commission as the homes registered manager. She has a clear understanding of the key principles and focus of the service and an open door approach to management. Her aim is to continually improve the quality of life for the people who use the service and to enable them to maintain or improve upon their independence. This aim has become part of the homes ethos and is embraced by all the staff. Staff told us that the manager would never expect us to do anything that she would not herself do. Another said being such a small stable home there is very much a family atmosphere here from which the people who use the service benefit. The AQAA provided evidences that there are good procedures for maintaining health and safety in the home and the records checked during this inspection, fire alarm testing, water temperatures and accident recording confirmed that these were properly maintained. The home follows quality assurance procedures with quality surveys being sent annually to service users, relatives and other professional stakeholders in the home. The results are collated into a report which is discussed with all staff by the Associations managers. Since the last inspection the homes Manager has been invited to address the Associations Management Board concerning the achievements and progress of the homes. Evidence: The homes records evidenced that all staff have regular supervision and an annual appraisal. Staff reported that they are well supported by the managers and that being a small home there was always someone to consult if they were ever in any doubt. 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 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 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 20 It is recommended that the home has a controlled drugs cabinet and register so as to be able to safely store and administer any such medication immediately upon it being prescribed. 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). 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