Inspection on 16/12/09 for 2 Central Avenue

This is the latest available inspection report for this service, carried out on 16th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2 Central Avenue 18/12/07

2 Central Avenue 04/07/07

2 Central Avenue 01/08/06

2 Central Avenue 05/12/05

2 Central Avenue 20/07/05

2 Central Avenue 01/02/05

2 Central Avenue 20/07/04

2 Central Avenue 12/01/04

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Coopers Mill Ltd

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Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 2 Central Avenue 2 Central Avenue Billericay Essex CM12 0QZ     The quality rating for this care home is:   one star adequate 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: Louise Bushell     Date: 1 6 1 2 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 33 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 33 Information about the care home Name of care home: Address: 2 Central Avenue 2 Central Avenue Billericay Essex CM12 0QZ 01277655394 01277655394 russell.groves@estuary.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Estuary Housing Association Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Central Avenue is a Care Home for four service users with Learning Disabilities. It is situated between Billericay and Stock. The home is registered for service users up to and over 65 years of age. The premises comprise of a bungalow with four single bedrooms, a bathroom, a lounge, kitchen/dining room and a small conservatory area with access to a large garden to the rear of the premises. There is also a garage for the homes minibus. The laundry area is situated in a room behind the garage. The premises are in keeping with the local community. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with information on the home. At this site visit the manager Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 4 4 0 2 1 2 2 0 0 8 Brief description of the care home advised that the weekly fee for a placement at 2 Central Avenue was £1615:00. Additional charges and costs are incurred by residents relating to chiropody, purchase of personal toiletries, bedroom furniture etc. No further information regarding fees has been obtained since the last report. Care Homes for Adults (18-65 years) Page 5 of 33 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 peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Care Quality Commission is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Assessment (AQAA) and reviewed what the service has improved in the last twelve Care Homes for Adults (18-65 years) Page 6 of 33 months and its plans for the next twelve months. The AQAA is a legal document that is required by law. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service. The visit took place between 9:30am and 14:30pm. We were able to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the manager. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: A number of areas for improvements have been identified for the service to make improvements with. Risk assessments and records regarding the management of risk must be reviewed and accurately reflect the needs of the individual. Risk assessments regarding the management and support of a persons health care needs must be reviewed. Care plans are required to be in place covering all aspects of a persons needs holistically. Further development and reviewing is required of the person centred plans Care Homes for Adults (18-65 years) Page 8 of 33 in order for these to be up to date, accurate and relevant to the person. Where a person requires additional guidelines and management plans, these must be completed. Staff must be suitably trained in Autism and receive adequate and frequent supervision and appraisals. The service could further explore the areas of equality and diversity of a person and how the service is best able to identify, document and action individuals needs. The service provides additional external space for activity to occur, however this needs to be completed and functioning as a usable space for all to access as they wish. A controlled drugs cabinet is required to ensure that the service is able to meet legislative requirements should a person be prescribed a controlled drug. Date of openings should be written on all bottles and boxs. The service should purchase a pill counter. A complaints and compliments logging system should be in place in order to ensure that all complaint and compliments are accurately recorded and managed. Service users should have the opportunity to have frequent meetings which should be recorded. There have been many areas of the environment that have been identified as requiring re decorating in order to ensure that the people using the service are residing in a comfortable, well maintained environment. 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 33 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 33 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 use the service can be assured that their basic needs will be identified through an assessment process, including a visit to the service. Evidence: The service has developed a Statement of Purpose and Service Users Guide, which sets out the aims and objectives of the service, which provides information about the service and the specialist care the service offers. The guide details what the prospective and current individuals can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. All new people are given a copy of the guide and the services makes one available for all to view as they wish. People using the service are also provided with a Charter for Housing. It was observed that people and or their representatives had signed the contracts and these were held on their files. Central Avenue currently provides people with placements through Local Authorities. This means that currently the people who use the service are funded through a Local Authority. There are no privately funded placements. Each person had a statement of their individual terms and conditions and these are reviewed and adjustments made Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: annually or as required. Contracts included information about additional charges made to people living in the service. Admissions are not made to the service until a needs assessment has been undertaken. The service has not had a new admission for a number of years. The person in charge during the inspection stated that the last admission was an emergency admission and stated we all managed this very well and the person is very settled. A skilled and trained person always completes the assessment prior to admission to the service. The assessment was satisfactory and identified specific areas of need. There was evidence that showed the assessment had been reviewed. The process followed was appropriate to the services policy and procedure in place. The AQAA states each service user that lives at Central Avenue is provided with a Statement of Purpose and Service User Guide. And we as a team also provide each service user with a clear and concise information about what they can expect from Central Avenue . The Statement of Purpose and Service User Guide were seen during the inspection and were available for people in the office. The assessment explored only a small number of areas of diversity included preferences and religious needs. The AQAA tells us that all the staff within the home promote equality and diversity by following Estuary Housing Associations policies and procedures, SOVA, Equal Opportunities, Staff Recruitment Policy and giving the service users the opportunity to talk about their personal needs, feelings and what they would like to do. The assessment process was reviewed annually and detailed information regarding personal preferences for the individual. The assessment evidenced a person centred approach, For example the assessment stated X will try to wash with a flannel. X will use the toilet. X can dress. X will brush own teeth and hair. It was also noted that likes and dislikes for the individual were noted in relation to diet, clothing, social interaction and activities. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. Information relating to social worker reviews was also held on the persons file. The service has the capacity to support people who use the service and respond to diverse needs, however the process for recording and identifying these is not detailed. One staff member commented that the service promotes independence. Service users needs are always met and carried out to the best possible standards. One person who uses the service commented, I like it here. Care Homes for Adults (18-65 years) Page 12 of 33 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. People using the service can not be assured that staff have detailed, up to date and accurate risk assessments available in order to meet their needs. Evidence: A total of two care plans were case tracked. It was established that people who use the service receive personal and healthcare support, which is suitable to meet their immediate needs. Personal healthcare needs including specialist health and dietary requirements are recorded in the health and medication file. The health record details individual support needs with medication and attendance at health appointments. Each area of health need for an individual has a risk assessment in place to support the person and the staff in empowering and enabling the individual. It was noted that these risk assessment were out of date and due for review. One relative commented its great, we have worked together to develop my son, he is a different person and I now feel like I have my son back. They are all fantastic. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: The care plan and the assessment tools provide information and a guide for staff to know how to support the person. The care plan format adopted by the service outlines the aim of the care plan, the skills of the person, the support needs and implementation needed. For example an aim stated to improve Xs communication skills. Each of the identified care plans then has a separate objectives sheet which outlines the task, for example, X to assist X with one to one in the garden. It was noted that the persons file only contained a total of two care plans. Information gathered from the person in charge during the inspection, feedback from professionals and other documentation held on site determined that one of the people case tracked is Autistic with some associated behaviours that may challenge. The care plan for the person did not detail any management guidelines for the staff to support the person and no record of how the person is supported in relation to their autistic tendencies. A professional commented on first impression a behaviour care plan was not in place for the service user referred to me. Some members of the larger service have received training in behavioural approaches. More staff could attend this training. In addition to the care planning folder each person using the service has a person centred plan in place. This is a pictorial document and details information specific to the individual. For example how the person communicates, like and dislikes and their life story. A number of personal preferences are recorded including the persons dreams for the future. At the end of the document separate goals are recorded for each person to receive support in achieving. These goals are set over a period of one month, three months, one year and five years. Each goal then has a separate action plan in place. The goals were implemented in 2006 and 2007, however since then no additional reviews have been noted or dated and no progress noted. The AQAA tells us that they could do better by updating service users PCP folders, we as a team can improve communication by using more photos of reference for our non-verbal service users in all areas to aid their input. Carers continue to maintain daily records regarding the care and activities of people living at the service. Risk assessments for the management and control of a range of issues, manual handling, shaving, dressing and grooming, hobbies and interest and collection of income. One person using the service commented, staff are always kind and friendly. A further individual commented yes, in response to being asked if they liked the staff. The AQAA states that the service users needs, likes and dislikes are reflected within their individual care plans and risk assessments. We encourage the service users to participate in decision making in all aspects of their daily lives, for example choosing what they would like to wear, helping with the house work, enrolling one service user Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: into college courses, offering taster sessions within the home and community, what they would like to eat and drink. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. The service listens and responds to individual choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs where appropriate. During the inspection it was directly observed that confidential records were being stored appropriately. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with support to make choices about their lifestyle and to develop their life skills. Evidence: People who use the service are supported to enjoy a stimulating lifestyle with a variety of options to choose from. Staff members were able to report that people who use the service were supported to attend various clubs, go to the theatre, cinema, swimming and many other activities. The people who use the service have opportunities at internal meetings to voice their wishes regarding social events and all other issues they wish to discuss. It was noted that the last service user meeting took place in June 2009. However the AQAA tells us that at Central Avenue we encourage the service users to be as independent as possible whilst participating in the running of the home and their lives and the service users partake in the housework with the staff on a regular basis. We hold service user meetings every three months. One service Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: user attends the service user forum meetings on the behalf of the other service users and gets information leaflets for trips out and up and coming events, this is done with the aid of their keyworker or any other home staff if the keyworker is not on duty that day. One person using the service stated I like doing my scrap books on a Saturday and Sunday. In addition to this the person stated I like to play cricket, basketball and football at college. On the day of the inspection one person confirmed that they enjoyed going out shopping, whilst another person was being supported to change their bed and tidy their room. People who use the service were also accessing further activity sessions and college. In relation to how the service has improved within the last twelve months, the AQAA states we are ensuring that all the service users are having more social activities both in the community and in the home and enrolling one of our service user into college. The service sought the views of the people who use the service and their representatives and considered these when planning the routines of daily living and arranging activities. Routines and activities were flexible and focused around individuals changing needs and choices. The service has an external converted garage space which was partly completed and to be used as an activity craft room. The member of staff on duty stated that this was still not fully completed and not being used. One person using the service commented we help do the shopping for the home. In the dinning room of the service there is a large pictorial board which helps the people using the service to know and understand any planned activities for the day. One person using the service talked about how the board worked. Meals were well balanced and nutritional, catering for the varying choices and dietary needs of the people living at the service. Food stocks were of good quality and in appropriate quantities. The AQAA determines that within the home we have a menu for the week which is done over the weekend with the service users having an input into what they would like for the coming week, the menu is only a guide to aid in the weeks shopping if a service user does not like what is on the menu that day then the alternative is recorded in the nutrition sheet. The service users are offered a balanced and varied menu and a variety of drinks throughout the day. One person using the service stated that the food is nice and I like cooking. Care Homes for Adults (18-65 years) Page 17 of 33 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. People who use the service can be assured that their health and well being is maintained and thus minimising risk to the people using the service. Evidence: Files included information of individuals health needs and how these were to be met, however the information was contained within a variety of sources such as the daily records, the assessments and the medication and health file. While it was identified that holistically information was available, it was not presented on all occasions within the care plan which may result in important information being missed. Personal healthcare needs including specialist health and dietary requirements are recorded in the health file. The health record details individual support needs with medication and attendance at health appointments. Each area of health need for an individual has a risk assessment in place to support the person and the staff in empowering and enabling the individual. It was noted that these risk assessment were out of date and due for review. The delivery of personal care was individual and flexible according to changing needs and preferences. Guidance and support is provided with personal hygiene tasks where Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: required although where people are able to attend to their own personal hygiene needs they were encouraged to do so. External specialist support services are accessed as required. Feedback was received from an external professional who commented I have not been working with a client very long and have only visited 3 or 4 times. The staff are polite and appear to have the service users best interests in mind. Medication was stored in locked cabinets. Medication administration records viewed at this visit and were satisfactorily maintained. The person in charge at the time of the inspection commented that they had a good working relationship with the local pharmacist. The Medication Administration Records (MAR) were hand written, however upon inspection they were accurate as per the prescription details. All entries had been stock checked into the MAR and double signed. Records showed that staff receive an annual medication refresher training session linked with the internal policy and guidance. The AQAA highlights all service users have personal care plans and risk assessments that ensure that their individual needs are met and in a manner that both supports and encourages independence and ensures that their privacy and dignity is respected. The Service users all access the local GP and the Dentist, we have a Chiropodist that comes to the home six weekly, Aromatherapist once a week in the home for 3 of our service users. This was evidenced in the health records. During the inspection two peoples medication was case tracked in detail and general good practice principles were reviewed through out this process. A number of bottles and boxs did not have a date of opening on them. Medication checks occur daily and these are recoded on the daily handover sheet. The service does not have a pill counter in order to audit the medication. The service does not have a controlled drugs cabinet available in the eventuality that a person was prescribed a controlled drug, the service would not be able to store this as required. One person using the service commented the staff always ask us what we would like. There is nothing I am unhappy with. Service users have access to chiropodists, physiotherapists, Occupational Therapists, speech therapists, community nurses as necessary. The service maintains positive contact with these health professionals and staff support Service users to attend appointments and respect confidentiality. Care Homes for Adults (18-65 years) Page 19 of 33 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 service has a robust compliments and complaints procedure in place. People who use the service can be assured that their concerns are listened to and acted upon. Evidence: The service has an open culture, which allows people to express their views and concerns through a variety of methods. Feedback gained from one of the people who uses the service confirmed that they are aware of what to do if they are unhappy and wish or wish to make a complaint. The individual stated, If I was unhappy they would always sort it out. The service has a complaints policy and procedure and this is detailed in the service user guide. The AQAA determines that each service user has a complaints procedure in their which is in picture format and there is also a copy in the service user guide. The AQAA tells us that the service has not received any complaints in the last twelve months. The person in charge during the inspection stated that there are customer feedback forms completed for any complaints and compliments. During the inspection no record of previous compliments and r complaints were found to be recorded. The complaints procedure was not visibly on display within the service for individuals, visitors and staff to see. The service understood the procedure for safeguarding vulnerable adults. Training in the safeguarding and protection of vulnerable people had occurred. The AQAA tells us Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: that all staff attend safeguarding training annually. Some staff records were reviewed as part of the inspection process and it was identified that a number of staff received their training in March 2009. One staff member spoke about the training and the policies and procedures held on site. The policies and procedures relating to recruitment promotes the safety of the people who use the service through the completion of an enhanced Criminal Records Bureau (CRB) disclosures and two written references before a new staff member starts work at the service. The AQAA tells us that all staff must attend and receive SOVA (safeguarding of vulnerable adults) training as part of the mandatory training package. This training is updated on a yearly basis. Care Homes for Adults (18-65 years) Page 21 of 33 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. The people who use the service are provided with a safe, hygienic and homely environment ensuring that their independence, personal preferences and choices are acted upon at all times. A number of areas are tired and worn and improvements are required to ensure that people are living in a well maintained environment. Evidence: The service is homely, clean, and safe and reflects the individuals needs and preferences in the personal spaces provided. A number of the people using the service were keen to show us their bedrooms, which were well furnished and reflected the choices made by the individuals. The people who use the service are fully involved in decisions about the decoration of the individual bedrooms. Individuals choose to meet with families or friends in communal settings or privately. They also have access to a telephone where they can make calls. Individuals have full access to all facilities, enabling their independence to grow. The AQAA indicates that the service continues to make improvements. It states that the following improvements have been made over the past twelve months. COSHH assessments are updated and in order. The bathroom has been repaired as a high priority. . Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: One person using the service stated, I love my room. A further person commented Yes, in response to do you like your room. The service is domestic in style and offers individuals with a relaxed living space. However there are many areas of the service that require up grading in order to ensure that the people using the service are residing in a well maintained environment. Many areas of the service is looking tired and worn. Wall paper is peeling of a number of walls and paint work is worn and in need of attention. The main lounge provides a range of seating for people to use, however this is out dated. The boards and wall paper in the lounge are peeling in a number of areas. There are adequate bathing and toilet facilities available for people to use. The small toilet is in need of redecorating. The entrance hall way to the service is decorated in dark wood cladding. This is very dark and in need of redecorating. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding, including a commercial washing machine with a sluice programme for dealing with soiled linen. Appropriate hand-washing facilities of liquid soap and towels are situated in all en suite and bathroom facilities where staff may be required to provide assistance with personal care. The outdoor space available is of a good size and enables people to move around freely. The garden is mature. Care Homes for Adults (18-65 years) Page 23 of 33 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. The people using the service can be assured that staff are employed in suitable numbers to ensure that the needs of people are met at all times, however lack of specific training and supervisions may lead to a work force who are not equipped with up to date skills to support people. Evidence: People who use the service have confidence in the staff who care for them. Rotas show well thought out and creative ways of making sure that the service is staffed efficiently. The service users and staff were able to confirm that two staff on on duty during the day and one person at night. It was directly observed that the staff on duty were supportive to all individuals and spoke to them with dignity and respect at all times. Staff members undertake some external qualifications. The AQAA tells us that all staff are trained in the role of the Support Worker and they all receive their mandatory training which is recorded in individual training plans and certificates are kept in the staffs development portfolio folders which is kept within the office. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for individuals and is not led by Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: staff requirements. Training is managed through Estuary where courses are identified for people to attend through their individual training plans. One member of staff spoken to during the inspection process confirmed that they had attended training in Mental Capacity Act. Records showed that some staff have attended training in risk assessment, safeguarding of vulnerable adults, Excel IT skills, manual handling and food hygiene. Although staff files contained the information required the folders were dis ordered and it was difficult to ensure that the current documentation was seen. There was no provision of Autism training at the service event though one of the people using the service has Autism. The AQAA states that all the staff have received CRB (criminal record bureau) checks, and all personal details about the members of staff are kept within our grey box in the home.. All staff are required to provide satisfactory references and CRB checks before they commence employment. Three staff files were reviewed on the day of the inspection. Staff recruited confirm that the home was clear about what was involved at all stages and was robust in following its procedure. One staff member commented that everyone gets on well and works as a team. In addition to this the staff member commented that good team work. One staff member also confirmed that supervision can occur at any time. The staff member stated but normally every two months. Records showed that staff are not receiving adequate supervisions and or appraisals. The AQAA identifies that the acting manager would like to attend appraisal training in order to complete these within the next twelve months. Records show that supervisions occurring in 2009 have not been frequent for all staff. The AQAA supports this statement and comments in relation to, what we could do better by stating to update the staffs supervisions. Care Homes for Adults (18-65 years) Page 25 of 33 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. People using the service can feel assured that the temporary management cover will ensure peoples immediate needs are being met. Evidence: The current manager has the required qualification and experience to run the home and meets its stated aims and objectives. This was evidened in their personal training plan. Staff were able to confirm that the manager communicates a clear sense of direction, is able to evidence a sound understanding and application of best practice operational systems. The AQAA received from the service also determines that they are planning to make improvements to initiate regular service user meetings in the home to discuss topics such as to what they want to see on the menus, what sort of activities in house and in the community they would like to participate in and to be given the opportunity to air their views and opinions. The ethos and leadership style of the service supports and enables people to express their diversity needs including their race, gender, sexuality and age. The service is aware for the need to further develop the documentary evidence to support this open approach and empowering staff and individuals to ensure that their cultural and diverse needs met at all times. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: The manager ensures that staff follow the policies and procedures of the service. Practice and performance are discussed during supervision, staff training and team meetings. One member of staff commented and confirmed that these areas are explored in these one to one sessions. Records reviewed as part of the inspection process confirmed this. There is evidence that the ethos of the home is open and transparent. The views of both people who use the service and staff are listened to, and valued. The AQAA contains satisfactory information that is supported by appropriate evidence. The service demonstrates a level of self-awareness and recognises the areas that it still needs to improve, and has clearly detailed ways in which they are planning to do this. The service has efficient systems to ensure effective safeguarding and management of money and valuables, including record keeping. People are supported to manage their own money where possible. Those who do not currently have the skills are encouraged and supported to develop to become as independent as possible. They have access to their records whenever they wish. Records are kept securely and staff are aware of the requirements of the Data Protection Act. The service has a comprehensive range of policies and procedures to promote and protect residents and employees health and safety. There is full and clearly written recording of all safety checks and accidents. The manager, senior team, and staff at all levels have a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. Evidence gathered during the inspection highlighted that there is a need for a number of risk assessments to be reviewed as active documents. Lockable storage is available for people if they choose. One person using the service commented that the staff are very good, and kind to me. One staff member commented the manager is a nice person, you know where you are with X. If you need to change a shift, its ok, X will listen to us and shes ok. Care Homes for Adults (18-65 years) Page 27 of 33 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 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Appropriate behavioural management guidelines must be in place where required and incorporated into a persons plan of care. To ensure that staff have access to up to date, accurate information in order to meet each persons needs. 04/03/2010 2 6 15 Each person using the 04/03/2010 service must have a detailed plan of care identifying, recording and reviewing all areas of need. To ensure that staff have access to up to date, accurate information in order to meet each persons needs. 3 6 17 The service must ensure 04/03/2010 that records maintained are an accurate reflection of the persons entire needs, reviewed active and current. Page 29 of 33 Care Homes for Adults (18-65 years) 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 To ensure that information regarding an individual is a true, accurate, reflective account of the individual. 4 19 17 Where risks have been 12/02/2010 identified and risk assessments have been implemented, these must be accurate, up to date and reviewed as specified. To ensure that staff supporting individuals have accurate, up to date information in order to ensure they are supporting an individual as required. 5 20 13 Suitable storage facilities must be provided for the safe keeping of controlled drugs. To ensure that where circumstances arise that controlled medication can be stored in accordance with legislation. 6 24 16 The service must ensure that it is satisfactorily maintained and decorated. To ensure that people using the service reside in a pleasant environment. 7 32 18 Staff must receive training in Autism awareness. 31/03/2010 31/03/2010 18/02/2010 Care Homes for Adults (18-65 years) Page 30 of 33 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 In order to meet the specific needs of people using the service. 8 36 18 Staff must receive suitable supervision and appraisals. In order to ensure that staff are equipped with the support and direction required to meet peoples changing needs. 9 37 9 The service must ensure that a manager becomes registered with the Care Quality Commission. To ensure that the person is fit to manage the care service in the best interest of the people using the service. 10 41 13 Risk assessments must be reviewed in order to ensure working practices are reviewed and up to date for all people. To ensure that people are suitably supported in a satisfactory way where risks have been minimised if possible. 25/02/2010 26/02/2010 04/02/2010 Care Homes for Adults (18-65 years) Page 31 of 33 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 2 3 4 5 6 7 2 6 12 20 20 22 36 Further exploration should be made in relation to equality and diversity issues for each person using the service. Person Centred Plans should be up to date and representative of active goals for the person. The outdoor converted garage space should be completed and used as an activity room as intended. A pill counter should be available. All bottles and boxs should have a date of opening on them. A complaints and compliments logging system should be in place to accurately record information. The acting manager should attend appraisal training. Care Homes for Adults (18-65 years) Page 32 of 33 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). 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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