Care Home: West Avenue

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: West Avenue 32 West Avenue Pennsylvania Exeter Devon EX4 4SD 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: Rachel Fleet Date: 2 3 1 0 2 0 0 8 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: West Avenue 32 West Avenue Pennsylvania Exeter Devon EX4 4SD 01392270760 01392270872 sdtickner@moduscare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Modus Care Limited Name of registered manager (if applicable) Simon De Fraine Tickner Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: Date of last inspection A bit about the care home West Avenue is a care home for 6 adults below retirement age, who have learning disabilities. Modus Care, the homes owner, provides services for people who need a lot of support because they have Autistic Spectrum Disorders and related conditions. The home does not offer nursing care. The home is a large detached house, near the centre of Exeter and next to a park. It has a car park and an enclosed, paved garden. There are 6 single bedrooms upstairs, each with a shower room and toilet. There is also a bathroom, if people want a bath instead. People have to be able to use the stairs, because there is no lift at the home. There is a choice of dayrooms, a dining room, kitchen, and laundry area. Weekly fees depend on peoples needs, so are agreed individually. People can get our inspection reports from the home. 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: One Star Adequate 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 This key inspection was was part of our usual inspection programme. Before we visited, the homes owners Modus Care filled in a survey about the home for us. This was called the Annual Quality Assurance Assessment or AQAA. It told us no-one had lived or worked at the home since our last visit. It also told us their plans for the home. We arranged that Steve Lawson, the Responsible Individual, would meet us at the home so that we could inspect it. We looked around, read some information and forms that would be used if anyone went to live there, and spoke with Steve Lawson. Mr Lawson is going to tell us if people move in, so that we can visit again to make sure they are getting the right support and have a nice, safe home to live in. What the care home does well Everyone can have their own room, with their own shower and toilet. There are other toilet, bathing and showering facilities at the home. People can have a choice of rooms to use when theyre not in their bedroom. What has got better from the last inspection What the care home could do better Several regulations for care homes for adults must to be met before anyone moves in, and the owners should try to meet the minimum standards for such care homes, before anyone moves in. Especially: There must be better information for people who ask about moving into the home, so they can make a proper choice about where to live. The home must be made a nice place, and a safe place, to live. There must be a good staff team, so that people living at the home are supported well and the home is run in their best interests. 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 Rachel Fleet 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. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Current information about the home is not sufficient to help people make an informed choice about where to live. There is a thorough approach to assessing prospective residents, ensuring people will get support to meet their individual needs, wishes and goals if they move in. But the outcome for individuals cannot be verified until people are admitted to the home. Evidence: The Responsible Individual, Steve Lawson confirmed the Statement of Purpose and Service User Guide will be updated to reflect the service and facilities offered by the home, with copies sent to us, before anyone moves in. He said they are produced in a form suited to the individual concerned, with regard for any specific communication needs. The home has been empty for over a year. We were told the home will not take emergency admissions, since pre-admission processes usually take 3-6 months to ensure the success of any admissions to the home. Senior staff would meet any prospective resident, assessing and identifying their needs over a period of time. Information would also be sought from any current carers. If it would be helpful to the individual, they are invited to visit the home. The impact of each possible admission on other people already living at the home would be considered, before offering a service to someone new. 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 . There are systems in place to ensure individuals are enabled to safely live a fulfilling life of their choosing, although such an outcome cannot be verified whilst there are no service users. Evidence: Care plan outlines encourage identification of individuals needs and goals, with crisis/contingency plans, interventions and support to be included as necessary, with who is responsible for these. Risk assessments would be included within the care plan, to ensure staff were fully informed of what support an individual needed to safely live a full life. The AQAA said care planning would be person-centered. It was clear from conversation with the Responsible Individual that staff will be expected to involve individuals in the planning of their care, through support and advice from other relevant professionals if necessary to achieve this. Advocacy would also be offered. The company has access to specialist advice on capacity, to ensure peoples rights are upheld with particular regard for the Mental Capacity Act 2005. There is documentation for recording capacity assessments and best interest decision-making, etc. If staff from the service have to act as appointee, Steve Lawson assured us that this would be audited. Family and or care managers would be consulted before any large expenditure of an individuals money took place. We were told staff receive extra training if necessary to meet individuals particular or Evidence: more diverse needs (such as communication methods). 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The philosophy and intentions of the home, if followed through, will promote individuals healthy development and fulfillment, although the outcome for individuals cannot be verified while there is no-on using the service. Evidence: The AQAA said that people would be helped to work towards their aspirations. The home is not intended to be a home for life for everyone who moves in, with development of independence to be part of daily life for anyone living at the home. They would be encouraged to shop, cook, do their laundry, etc. Educational and work opportunities would be explored. There will be a budget specifically for individuals recreation - for outings, holidays, etc. - with support to become part of the community. Eating together would also be encouraged, with guidance on choosing a balanced diet. If people wanted to eat alone, the reasons for this would be identified and included in their care plan, with regard for their overall wellbeing and their other needs. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The homes policies and multidisciplinary approach will help to ensure people living at the home receive the support and health care they need, although the outcome for individuals cannot be verified whilst there are no people using the service. Evidence: The AQAA said peoples independence would be promoted, they would be helped to access services necessary for the meeting of their physical, emotional and mental health needs. Multidisciplinary support would be sought, according to their needs. Equipment, fittings, etc. would be obtained to meet individuals various needs. There are secure storage facilities, with a comprehensive medication policy, available for medication. Steve Lawson confirmed medication training for staff included observation of their practice. Self-medication would be risk assessed, with stated options including getting a multidisciplinary decision on this. We had assurances at our last inspection that should someone move to the home from another county, the home would first require confirmation from that countys authority that handover of responsibilities had been agreed with Devons health and social services authorities. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Systems are in place to enable peoples complaints to be heard and to protect them from abuse. However, more information for staff would assure people using the service that they will be robustly safeguarded. Evidence: There is a written complaints procedure in both standard and easy read formats. It would be included in information given to people enquiring about the service, and explained to people when staff discuss the homes Service User Guide with them after their admission. Our contact details needed amending in the copies we saw, with inclusion of the fact that people may contact us at any point in the complaints process. The Responsible Individual has experience of handling allegations and disclosures. The AQAA stated that staff induction, supervision and meetings will include safeguarding training and other related matters. Steve Lawson agreed to make the homes written policy more robust by including more detail about Devon County Councils safeguarding procedures, so staff would be clear as to how to report any concerns about abuse. He told us the companys trainer includes the local procedures in their training also. We were also told that the company has an ethos of working on the environment individuals live in, so that they are not forced to react or behave in a way that challenges staff. Triggers are identified, a Behavioral Therapist is available, the emphasis is on positives, etc. - a proactive rather than a reactive approach, where safety not control is promoted. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Plans are in place to ensure people will have pleasant and suitable accommodation, but the home is not currently habitable. Evidence: Bedrooms, all for single occupancy only, are on the upper floor. They vary in shape and size. All have en suite shower and toilet facilities, and can be locked by the room occupant if they wish. Window restrictors were in place where we checked at random. There is only stair access between floors at present. The home has two lounge areas, a dining room, a domestic kitchen with additional food preparation area, a laundry room and a toilet/shower room, on the ground floor. The home has been unoccupied for some time, some carpets need attention, some areas have water damage, rooms are not furnished and ready for use, etc. Thus cleaning, attention to decor and refurbishment will be needed before anyone goes to live there. Steve Lawson, the Responsible Individual, confirmed an action plan has been drawn up to make the home habitable. Similarly there is a partly paved, secure garden area, with level access from the house, which is to be attended to before anyone moves in. We discussed that a high step in the area needed to be risk assessed. In the process of registering this service, we required that door locks on the front door and doors within the home be changed or removed, to ensure people had freedom of movement. Steve Lawson confirmed this would be addressed before anyone moved in. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . None. Evidence: No staff are employed. Steve Lawson, Responsible Individual, was fully aware that relevant regulations and standards must be met when creating a staff team in future. He intends that experienced staff will be specifically employed and trained to support and care for any individual who wishes to move into the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Arrangements for managing this service and ensuring it is run in the best interests of people who live at the home have been devised, but are still to be implemented. Evidence: There is no manager at present. Steve Lawson, Responsible Individual, intends to recruit a manager once there are definite plans to admit people to the home; the AQAA indicated an application to register a manager would be made before anyone was admitted. We looked at systems proposed for ensuring the quality of the service. These included regular audits of care planning, maintenance checks, etc., with the manager subsequently producing a report for their line manager. The AQAA included that the registered provider would arrange for external staff to carry out regular unannounced visits, as required by the Commission. We were told how people using the service would be consulted, to inform its future development. The home would have access to the companys own Speech and Language Therapist, who assists with peoples different communication needs so that they are enabled to express their views. A survey entitled My views would be available. Advocacy would be offered. A pest control company monitors the premises. The AQAA stated that fire safety, risks from Legionella, and electrical safety would be fully addressed before anyone moved into the home; environmental risk assessments would be carried out, with any necessary action taken. On our visit, Steve Lawson confirmed safety of gas appliances would also be ensured. 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 1 1 6 To make sure that there is 31/12/2008 current and accurate information about the service offered, you must. (a) Keep under review and, where appropriate, revise the statement of purpose and the Service users guide; and. (b) Notify the Commission and service users of any such revision within 28 days. 2 24 23 (1) (2) To make sure that people 31/12/2008 living at the home are able to move freely around and out of the home, internal door locks on communal room doors should be removed and the front door lock should be changed, to make sure that people cannot be locked in against their will. This requirement must be met within the timescale given or before anyone moves into the home whichever comes first. This requirement is outstanding from the last inspection. 3 42 23 (4) To make sure that people 31/12/2008 living at the home are properly protected from the risk of fire, the homes arrangements for preventing, detecting and escaping fire should meet with the standards expected by the local fire authority. Action should be taken to achieve compliance with current fire safety legislation, including that the Homes own fire risk assessment must be reviewed and acted upon as needed, and seeking advice from Devon Fire Safety Authority. Written confirmation that this has been done should be provided to the Commission. This requirement must be met within the timescale given or before anyone moves into the home whichever comes first. This requirement is outstanding from the last inspection. 4 42 13(4) To make sure that people 31/12/2008 moving into the home are safe, the registered person shall ensure that (a) All parts of the home to which they have access are, so far as reasonably practicable, free from hazards to their safety; (b) Any activities in which they participate are, so far as reasonably practicable, free from avoidable risks; and. (c) Unnecessary risks to their health or safety are identified and so far as possible eliminated. This includes risks related to Legionella, gas appliances, electrical equipment, outdoor areas, unrestricted windows, etc. This requirement must be met within the timescale given or before anyone moves into the home whichever comes first. 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 24 16 16(2)(c) You must provide, 31/12/2008 in rooms used by people living at the home, adequate furniture and furnishings, So the home meets peoples individual and collective needs in a comfortable and homely way. This requirement must be met within the timescale given or before anyone moves into the home, whichever comes first. 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 23 To ensure people using the service are properly safeguarded, all staff should receive training or information by other means on how to report concerns or allegations about abuse. 2 3 4 24 26 30 Before people move in, the environment should be well maintained and homely. Peoples bedrooms have sufficient furniture and fittings to meet their individual needs and lifestyles. Before people move in, the environment should be clean and hygienic, with systems in place to control the spread of infection, in line with relevant legislation and published guidance. 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. 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