Inspection on 08/07/09 for 1 & 2 Turnbull Place

This is the latest available inspection report for this service, carried out on 8th July 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

1 & 2 Turnbull Place 20/06/06

1 & 2 Turnbull Place 10/01/06

1 & 2 Turnbull Place 01/10/04

1 & 2 Turnbull Place 23/04/04

1 & 2 Turnbull Place 11/03/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 1 & 2 Turnbull Place Riding Lane Hildenborough Tonbridge Kent TN11 9LN     The quality rating for this care home is:   three star excellent 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: Wendy Mills     Date: 0 8 0 7 2 0 0 9 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 31 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 1 & 2 Turnbull Place Riding Lane Hildenborough Tonbridge Kent TN11 9LN 01732838876 01732838876 Turnbull.Place@theavenuestrust.co.uk glebe.house@theavenuestrust.co.uk Avenues Support Services care home 5 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. The registered person may provide the following category/ies of service only: Care home only - (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 (LD). Date of last inspection Brief description of the care home 1 & 2 Turnbull Place is a registered care home providing care and support for up to five people with learning disabilities and other associated impairments. The registered provider is The Avenues Trust. The Trust has a number of other care homes in the local area. The home consists of two detached bungalows that are next door to each other. Each bungalow has a kitchen and a living room with dining area. One bungalow has two bedrooms and the other has three. All bedrooms are for single occupancy. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 5 Brief description of the care home Outside both bungalows have large enclosed gardens to the rear and plenty of off road parking to the front. The home is located in a country lane about one mile from the village of Hildenborough where there are some shops, a library and bus services to Tonbridge and Sevenoaks. Hildenborough also has a train station. The weekly fees for this home were given as circa £1,500 at the time of this visit. Fees are based upon the assessed needs of the individual service user. Further infomation about the home can be obtained from the registered manager on request. Care Homes for Adults (18-65 years) Page 5 of 31 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: three star excellent 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: This visit formed part of the annual regulatory process of the newly formed Care Quality Commission (CQC) under the Care Standards Act. This report is based on evidence we have gathered during this visit and information we have received throughout the year. This includes the homes Annual Quality Assurance Assessment (AQAA) document, notifications required by the Act and information other people have told us, such as the results of surveys and the views of visiting health nd social care professionals. Our findings are then used to make a judgement about the star quality rating for the service. During this visit we met all the people who use this service. We were able to speak to three of them and observed the interactions of the others. We spoke to two members of staff in private and another during a tour of the home. In depth discussion was held with the registered manager, a tour of the home was made and important documentation, such as individual service user plans, and staff files was examined. Care Homes for Adults (18-65 years) Page 6 of 31 The people who live in this home, their supporters and staff all made very positive comments about the service. One said, I like it here, we can help with things and we are happy. Staff described the home as a lovely place to work and said they get a lot of job satisfaction from seeing the progress that the people they support are making. The people who use this service, their supporters, staff, the registered manager and the area manager are all thanked for the welcome they gave and their help throughout this visit. The star quality rating for this service is 3 Stars. This means that the people the home supports experience excellent outcomes in the most important aspects of their care and support. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The bathrooms would benefit from a complete refurbishment to make them more Care Homes for Adults (18-65 years) Page 8 of 31 accessible for the people that use this service and easier for staff to support them. It is important for the home to be proactive in this area as several of the people who use this service are now showing signs of aging and may need more specialist bath and toilet aids in the future. 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 9 of 31 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 10 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home gives prospective service users and their supporters the information they need so they can make an informed decision about moving into the home. Thorough pre-admission assessments are made to ensure that only those people whose needs can be met and who are suitable for the home will be offered a place there. Evidence: The home has a comprehensive statement of purpose and service user guide. Information about the home is available in easy read, pictorial and audio formats. The registered manager said that the staff are very good at explaining things to the people who live in the home. Observation showed that the people who use this service are relaxed in their environment and relate well to staff. The care plans of the most recently admitted service users were examined. Both had comprehensive needs assessments on file. There was good evidence that a lot of work had been done, visiting and arranging visits to the home, before a place at the home Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: was offered. Inspection of the care plans showed that all the people who use this service have comprehensive assessments on file. This include a cultural assessment and health and personal needs. Care Homes for Adults (18-65 years) Page 12 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home supports the people it supports to make as many decisions as possible about the way they lead their lives and to take appropriate risks. Where a service user cannot make an informed decision then their best interests are put to the fore in the spirit of the Mental Capacity Act. Evidence: Three care plans were examined. The home calls these Person Centred plans (PCPS). Care plans are important documents because they are one of the means by which the people who use this service and their supported know that their care and support will be given in the way they would wish. In addition, they are an important source of reference for staff and can provide a basis for decision making when someone may not have full mental capacity. The care plans are comprehensive and clearly identify the needs and wishes of the people who use this service. There are clear policies and procedures in place to help people who may not have full mental capacity to make informed decisions. Risk Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: assessments are in place of both environmental and individual risks. The Avenues Trust, the registered provider, has developed a system for giving the people who use the service a chance to try different activities and broaden their horizons. They run sessions, called, Opportunity Sessions, that give individual service users the chance to try out new and different activities to see if they would like to chose something other than their usual routines. There is a written document that supports the process for these sessions. The registered manager said that the people who use this service have made good progress in increasing the level and variety of their activities. One service user in particular really enjoys participating in all activities both in and outside the home and she has now encouraged others to be more active and make wider choices. The registered manager has a good working knowledge of the new Mental Capacity Act and how it may influence the way care is given. Best interest meetings are held when serious decisions need to be made and the registered manager described the decision making progress for the placement of one service user following loss of mobility and a hospital admission. From this discussion and the written evidence in the care plan it was clear that all the appropriate people, including supporters, staff and health and social care professionals had been consulted before a decision was made on behalf of someone who was not fully able to make this for themselves. The decision was made for this person to eventually return to the home and it was really good to note that a great deal of progress has been made and the person has now regained almost all of their previous mobility. The staff at the home are commended for their input into the decision making progress and the way they have worked to ensure the wishes of the individual were fulfilled. The home takes a person centred active support approach to care and support. This means that they put the service user at the centre of everything they do and encourage participation in every activity in the home. The people who live in the home participate, as much as they wish and are able, in the day to day running of the home. They get involved in planning what they want to eat and help out with the shopping to buy food. On the day of this visit one person was very busy helping put away shopping and making preparations for the evening meal. Care Homes for Adults (18-65 years) Page 14 of 31 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 excellent 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 this home have a wide choice of activities and opportunities so that they can lead active, meaningful and interesting lives. Evidence: The homes Annual Quality Assurance Assessment (AQAA) document told us that the Avenues Trust has embraced the concept of Person Centred Active Support (PCAS). This approach put the person the home supports at the centre of everything the service does and encourages support staff to move from being carers to enablers. Activities are tailored to the individual and all activities are assessed to ensure the maximum participation in whatever activity is going on whether it be household chores, local church activities, visits to the cinema or clubs. Staff encourage the people they support to learn as many skills in the home and in the Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: local community as possible so that they can gain more independence and self esteem. As a result of this approach service users have become valued members of the local community. One is a regular church goer who becomes involved in other church activities such as fetes and bazaars. This person also belongs to the local older peoples club and is now able to attend events with the club without support from staff at the home. The care plans clearly identify the likes and dislikes, preferences for activities and outings, cultural and religious needs. The staff team are well motivated and committed to ensuring that the people they support get out every day. They participate in a variety of activities from menu planning and food shopping to theatre trips and swimming. Each person has had a financial assessment that determines how much support they need to manage their money. The people who live in the home have their own bank accounts and go to the bank, with support, to draw money out and put money in. They are known by the bank staff. Clear financial records are kept and there is a sound system for auditing these. The home also carried out a cultural needs assessment for each person. This assessment gives information about religious and cultural needs, likes and dislikes and some background information about each person. The service is very clear about the way it values equality and diversity. There are robust policies in place and all staff have received training in equality and diversity and empathic support. There is a good age, gender and skill range amongst the staff and each staff member is encouraged to bring their own skills and experience to the home to enhance the lives of the people who live there. For example, one service user enjoys colour and art and a staff member who is very artistic helped him plan and paint a design on his window. Staff were observed to positively encourage the people who they support to maintain their mobility and to participate in decision making about day-to-day life in the home. The people we spoke to all said they are happy living in the home. One said that she especially likes gardening, going out shopping and having a cup coffee and going swimming. Another said that she really enjoyed going out to clubs. Other activities include barbeques, discos, music and other sensory equipment such a coloured lights, cooking and bowling. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Each person has an activity plan and their preferred activities are recorded. Opportunity sessions help to encourage people to try new experiences. The registered manager described how one of these sessions identifies that one person would like to go to church This was arranged but the person did not seem to enjoy the experience. The home looked at other churches in the area to see if they could meet the needs better but in the end the service user decided not to continue to attend church. The Trust carries out a service audit each year. This year the audit focused on healthy lifestyles. Within the Trust there is a Sports and Active Lifestyles group that looks at how all service users can be encouraged to access, and take part in, more sports and other physical activities. On the day of this visit one of the people the home supports had just returned from food shopping and was helping to put this away. From observation, it was clear that there was plenty of good quality, fresh produce. It was good to note the chat between the people who live in the home about the evening meal and see their input into food preparation. Care Homes for Adults (18-65 years) Page 17 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home positively promotes the health and well being of the people who live there so that they can enjoy as healthy life as possible. Evidence: The individual care plans are in good order and up-to-date. They give good and clear information about the health and personal care needs of the people who are supported by this service. There are moving and handling and risk assessments in place and we found good evidence to show that these have been recently reviewed. All the people who use this service are registered with General Practitioners (GPs) and use local health services. There are regular reviews of medication and preventative screening by the GP and all service users are up to date with these checks. Health and social care professionals, such as physiotherapists, ophthalmologists and dietitians, are accessed as necessary. There is good written evidence that their advice is sought and followed appropriately. Staff spoke of how they have recently been Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: working with the community physiotherapist to improve the mobility of one of the people in the home. The home takes a proactive approach to the health and wellbeing of the people that live there. Each person has a key worker who helps develop their health action plan and ensures that this reviewed monthly. Observation showed that the privacy and dignity of each person is respected by staff. Bedroom doors are fitted with locks and staff were observed to knock on doors and seek permission to enter rooms. There are clear gender guidelines for personal care. Throughout this visit staff were seen to treat the people they support with kindness and in an encouraging and supportive manner. There are sound policies and procedures for the management and administration of medicines. All staff receive training in the administration of medicines. They also have a yearly medication assessment. The way that each person prefers to take their medicines is recorded. The service has done a lot of work in dealing with the issues around aging, illness and dying. There is a document called, When I die, that those service users who wish are supported to complete. This document records wishes such as which hymns or songs to be played at a funeral, whether cremation or burial is desired and any other last wishes. There is good recognition of the effects of aging amongst staff. The home and the organisation are commended for the work they have done in dealing with this sensitive subject. Care Homes for Adults (18-65 years) Page 19 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home listens to the concerns of the people who use this service and their supporters so that they can be confident that these will be acted upon in an efficient and effective way. Evidence: The home has sound policies and procedures for managing concerns, complaints and safeguarding. Staff are aware of these and say that they would always be prepared to make a complaint on behalf of a service user if necessary. A copy of the complaints procedure is displayed in the home and also contained in the Service User Guide. Relatives and other supporters are made aware of this procedure which is also available in pictorial and audio format. All staff have received safeguarding training to ensure they understand how to spot and prevent all forms of abuse. They are also given a handbook when they start their employment with the Trust. This gives details of the Code of Conduct for Social Care and tells staff how to report any safeguarding concerns. There are regular staff and team meetings where staff are encouraged to put forward ideas and concerns. Recruitment procedures are robust and ensure that only carefully vetted staff are offered employment at the home. There have been no formal complaints since the last inspection. We were told that day to day concerns are dealt with as they arise and the details are recorded on the daily Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: handover sheets. The home runs a key worker system. This means that each person has a named member of staff who takes the lead in ensuring that reviews take place, specialist appointments are kept and that lines of communication between relatives and other supporters are kept open. Opportunity sessions are used to help the people the home supports express any concerns they may have. Staff say they advocate on behalf of the people they support when necessary, helping them to communicate their wishes as clearly as possible. As part of the monthly quality audit, complaints and safeguarding issues are reviewed. Should there be any safeguarding alerts these would be reviewed by the executive management team. Care Homes for Adults (18-65 years) Page 21 of 31 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 home is very clean, safe and well maintained. It provides a pleasant and homely place in which the people who are supported by the service can enjoy their lives. Evidence: The home consists of two detached bungalows standing side by side. Both bungalows are wheelchair accessible and there are grip rails in the corridors. Several of the people the home supports are now showing signs of aging and need more adaptations. Currently the bathrooms and toilets meet their needs and aids such as raised toilet seats are in place. However, the bathrooms would benefit from a complete redesign and refurbishment to make access easier. This would mean that the home would be able to meet the needs of the people who live there for longer. The home was very clean, comfortable and uncluttered on the day of this visit. There was a friendly and welcoming atmosphere and the people who use this service were observed to be confident in moving around that home. There is an ongoing programme of redecoration and all areas were seen to be in good decorative order on the day of this visit. The Homes Annual Quality Assurance Assessment (AQAA) document told us that the home has sound infection control policies and procedures, regular health and safety Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: checks and satisfactory fire precautions. There are environmental risk assessments for any parts of the home that are considered to pose a risk. No health and safety hazards were noted on the day of this visit. Outside there are large gardens and safe decking areas. The people who live in this home said that they enjoy the garden. One particularly enjoys gardening and growing vegetables for the home. Others said that they enjoy sitting on the decking and enjoying watching the horses in a nearby field. Care Homes for Adults (18-65 years) Page 23 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a stable, well qualified and enthusiastic staff team who are able to flexibly meet the needs of the people they support. Robust recruitment policies and procedures ensure that only those people who are suitable to work in the home are offered employment there. Evidence: The staffing levels are flexible to meet the needs of the people that the home supports. There are generally two staff members on duty on each day shift. However, more staff may be rostered should there be an indication of need. For example, should people be going out to different places at the same time or if illness or accident mean that the needs of an individual require more staff at a particular time. One bungalow has one wake night support worker and the other has a sleep night staff. There is an on call system should there be any unforeseen circumstances. The staffing establishment for this home is 16.5 Whole Time Equivalent. There are currently fifteen people working at the home. The additional hours are covered either by staff working some overtime or by bank staff. The home is in the process of recruiting two more staff. The staff team has a good age, ethnic and skill mix and the gender mix reflects the Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: gender mix of the people they support. This diversity amongst the staff enhances the lives of the people they support by bringing them a range different skills, experiences and ideas. The registered provider, the Avenues Trust, has its own training department called, The Avenues Academy. The Academy is proactive in developing training and identifying new areas where further training and development are needed. Individual staff learning and development needs are identified through one-to-one staff supervision sessions. The Trust has clear learning and development goals that include supporting staff to reach their full potential; ensuring that staff have the skills and knowledge to enable them to do their jobs effectively; developing different learning methods such as using open learning workbooks; and developing a culture of continuous learning, coaching and mentoring. Three staff files were examined. We found good evidence that there is a high level of staff training going on. Both statutory training such as health and safety and infection control, and specialist training such as diabetes, challenging behaviour and epilepsy, are available to staff. Staff training is carefully monitored. Five staff hold the National Vocational Qualification (NVQ) at level two or above. One member of staff is due to complete an NVQ very soon and two others are currently completing their induction period. Two staff members were spoken to in private. Both were very positive about their work and said that they enjoy supporting the people who live there. One said, The care here is very good. Staff give one hundred percent to make the lives of the people here as good as possible. Both staff praised the induction they had received and the support the registered manager gives them. Another said, They are very hot on training, they give us the support to do it but we know we have to commit to learning. Communication between the managers and staff is very good. There are monthly team meetings and one-to-one supervisions, daily staff hand-overs and good written information for staff. Staff said that they are consulted appropriately and are able to input ideas into the support programmes. The Trust has robust recruitment policies and procedures. Recruitment checks are carried out by the regional office to ensure consistence. Criminal Records Bureau Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: (CRB) and safeguarding (POVA First) checks are made; two written references are obtained and telephone checked if indicated; a full employment history is obtained and any gaps are looked at. Once a candidate has successfully completed the recruitment process and has been fully checked, there is an induction period where core skills are taught. Staff must successfully complete this period before being offered a permanent contract. No new member of staff is permitted to give personal care until both the individual service user and the staff member are comfortable with this. New staff attend at least thirteen training days within their first six months of employment. Care Homes for Adults (18-65 years) Page 26 of 31 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 excellent 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. The views of the people who use this service and their supporters, and the staff who support them, are listened to and acted upon so the home is run in the best interests of the people who live there. Evidence: The registered manager is well qualified and experienced. She holds the Registered Manager Award (RMA) and the National Vocational Award in Care at level four (NVQ IV). She has worked with the Trust for over ten years and has successfully managed the home for five years. Staff say she is a good manager who listens to their concerns and acts upon them. One said, She is very approachable, down to earth and will listen. Another said, She gave me time when I was new and worried about a few things - I feel happy that she will do the best for the people here. The registered provider is the Avenues Trust. This is a not for profit organisation that has many years experience of service provision for people with learning disabilities Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: and other associated problems such as visual and physical impairment. The Trust has sound organisational goals and excellent quality assurance systems. the quality assurance systems include regular staff ans stakeholder questionnaires, monthly quality check visits by a representative of the Trust and four monthly service reviews. The homes Annual Quality Assurance assessment (AQAA) was completed on time and gave us comprehensive information about the service. It told us that all necessary health and safety checks are carried out on a regular basis and that all certificates needed to ensure the health and safety of the people who use this service and the staff are in place. Environmental risk assessments are in place and a tour of the home confirmed that there is good attention to detail in respect of health and safety. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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