Inspection on 13/04/10 for Mount Avenue, 12

This is the latest available inspection report for this service, carried out on 13th April 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mount Avenue, 12 29/11/05

Mount Avenue, 12 15/08/05

Mount Avenue, 12 25/11/04

Mount Avenue, 12 20/05/04

Mount Avenue, 12 31/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Mount Avenue, 12 12 Mount Avenue Bootle Liverpool Merseyside L20 6DT     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: Daniel Hamilton     Date: 1 3 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Mount Avenue, 12 12 Mount Avenue Bootle Liverpool Merseyside L20 6DT 01519442134 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.peterhouseschool.org Autism Initiatives Name of registered manager (if applicable) Mr Alan OLeary Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection Brief description of the care home 12 Mount Avenue is a mid-terraced property situated in a popular residential area of Bootle. The service is operated by Autism Initiatives. The home is located close to all public transport, leisure and shopping facilities. The home is registered as a care home for three adults who have a learning disability. All three residents who currently live in the home are men. The ground floor of the accommodation provides a lounge, dining room, fitted kitchen, toilet /shower room, and upstairs there is a bathroom, three large bedrooms and the office. At the rear of the house is a private yard, which is paved and Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 3 Brief description of the care home furnished for the use of residents. The overall philosophy of care is to enable the residents to live as independently as possible and to promote integration of them into all aspects of life at home and in the community. The cost for the service ranges from £1111.10 to £1032.28 per week depending on need. Care Homes for Adults (18-65 years) Page 5 of 32 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 quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. This unannounced inspection took place over one day and lasted approximately 8 hours. Three residents were living in 12 Mount Avenue at the time of the visit. A site visit took place as part of the unannounced inspection and a tour of the premises was completed. Two of the service users care files were case tracked (their care files were examined) and a selection of staff and service records were also viewed. The acting manager, two care staff and two relatives were spoken with during the inspection and all the people living in the home were encouraged to join in the inspection process using their preferred methods of communication and engagement. Reference was made to an Annual Quality Assurance Assessment (AQAA) which was Care Homes for Adults (18-65 years) Page 6 of 32 completed by the acting manager before the visit. This document enables a registered person to undertake an assessment of a service, prior to an inspection. Survey forms were also distributed prior to the inspection for residents, relatives and / or staff to complete. None were returned to the Commission. All the key standards were checked as part of the inspection process. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose should be updated to include all the information outlined in Schedule 1 of the Care Home Regulations 2001 and the Service User Guide should be updated to meet the criteria detailed in Regulation 5. This will ensure that people using the service and / or their representatives have access to all the necessary information on the service. All outstanding records relating to the care of service users should be brought up-todate and and more efficient systems should be established to ensure records are correctly completed. Visual resources and picture communication systems should be established to assist service users and staff to communicate more effectively. Optician appointments should be recorded and / or arranged to confirm the service users have their vision checked periodically. An up-to-date copy of the Registered Providers Complaint, Whistle blowing and a Service User Protection procedures should be obtained for staff to reference. Action should be taken to ensure any complaints received are investigated and responded to within 28 days to ensure compliance with the Care Home Regulations Care Homes for Adults (18-65 years) Page 8 of 32 2001. Records of all complaints, concerns and / or or allegations received together with the action taken and outcomes should be logged and available for reference at 12 Mount Avenue. A plan for the ongoing refurbishment and maintenance of the premises should be developed to ensure best practice. The kitchen units and cracked toilet should be repaired / replaced as soon as possible. Cleaning schedules should be reviewed and closely monitored to ensure the premises is kept clean and hygienic at all times. Records relating to the recruitment and training of staff must at all times be available for inspection at 12 Mount Avenue. This will provide evidence that staff are appropriately recruited, inducted and trained for their roles and confirm the welfare of service users is safeguarded. The fire alarm must be tested on a weekly basis and the emergency lights on a monthly basis and records maintained. This will safeguard the health and safety of service users and staff. A certificate must be obtained for the electrical wiring installation. This will help to verify that the electrical wiring installation for 12 Mount Avenue is safe. The fire extinguishers should be visually inspected on a monthly basis and records maintained. Day staff should complete fire instruction training at least every six months and night staff every three months and records maintained of the date of the training, the name of staff and their designation. The temperature of all hot water outlets should be tested and recorded on a monthly basis to confirm the temperature is limited to 43 degrees centigrade. The fire risk assessment should be revised and dated to ensure safe working practice. The registered provider should appoint a permanent manager to 12 Mount Avenue as a matter of priority and ensure a registration application is forwarded to the Care Quality Commission without delay. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users do not have access to comprehensive information on 12 Mount Avenue, to enable them to make an informed decision on the service provided. Evidence: The Annual Quality Assurance Assessment (AQAA) for 12 Mount Avenue detailed that the home had an up-to-date Service User Guide which had been updated in the past 12 months, together with a Statement of Purpose. The AQAA also detailed that the documents had been produced in an appropriate format for the needs of the people using the service. On the day of the visit the new acting manager reported that she was in the process of updating the Statement of Purpose and Service User Guide documentation which was not dated and did not contain all the necessary information required under the Care Home Regulations 2001. A file was viewed which contained a picture of the home and information regarding: the name and address of the Provider (Autism Initiatives) and Acting Manager; mission statement; description of the house; room sizes; emergency admission process and activities and community presence. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: Discussion with the Acting Manager and staff and examination of the AQAA revealed that no new service users had moved into 12 Mount Avenue since the last inspection. No issues of concern were noted at the last inspection concerning assessment practice and the AQAA confirmed that the Registered Provider had a comprehensive assessment procedure in place, which would be followed, to ensure the needs of prospective service users are taken into consideration. Care Homes for Adults (18-65 years) Page 12 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure the needs of service users are identified but some records are in need of review to ensure best practice. Evidence: The Annual Quality Assurance Assessment (AQAA) for 12 Mount Avenue confirmed staff had access to a policy on Individual Planning and Review. Two files were case tracked during the inspection. Both were found to contain information on the personal, social and health care needs of the service users and provided support staff with key information on how to communicate effectively. For example, the About me section of files included information on a range of areas including: communication, understanding, activities, staff support, getting on with people, morning and evening routines, meals, recognised sensory differences, pain or discomfort, choices and opinions, medication and health and safety. Additional information on long and short-term personal goals had also been outlined Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: within Support Plans and the responsibilities of the people using the service and the support required by staff had been identified. Furthermore, files contained a range of supporting documentation including positive intervention support plans, financial support plans, personal and background information, health care information, daily report records and other general information. It was noted that some key records had not been kept up-to-date or were not correctly dated and this was discussed with the manager during the visit. For example, one Positive Intervention Support Plan viewed had not been updated since December 2008, a hospital support plan was incomplete and detailed Xs [a service users] eye sight is very poor. He has a condition called ...... and the last review was Feb. Records indicated that the last review from Autism Initiatives for one service user was 20/06/06 and the 4/03/2008 for another. Gaps were also noted in the daily report books. Other examples were discussed with the acting manager during the visit. Service users were encouraged to participate in the inspection process using their preferred methods of communication. Likewise, the acting manager and staff on duty were seen to engage with service users in a positive, respectful and dignified manner. It was noted that there was limited visual resources and picture communication systems in operation at the home to enable service users to communicate. The acting manager acknowledged this observation and reported that she intended to introduce alternative communication systems for the benefit of service users and staff. The acting manager and staff confirmed that the people living at 12 Mount Avenue were supported to take responsible risks as part of their daily lives. A range of risk assessments had been completed to ensure personal, community based and environmental risks had been identified, together with the action and precautions required. Some risk assessments for service users were not personalised as the name of the service user had not always been recorded. This should be addressed. Care Homes for Adults (18-65 years) Page 14 of 32 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. Meals, activities and routines are well managed, flexible and varied to enable service users to have choice and control over their lifestyle. Evidence: Two of the people living at 12 Mount Avenue continued to attend day care facilities in addition to participating in a range of activities within their home and local community. Weekly activity programmes had been developed for all the service users and records of their participation in activities maintained. Activities included: visits to local pubs, shops and parks; swimming; meals out; trips to various destinations and participation in housework and other personal responsibilities. Staff reported that the people using the service had not received a holiday since the summer of 2008. The Annual Quality Assurance Assessment (AQAA) detailed that the service was in the process of organising a holiday destination for the people living at 12 Mount Avenue. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Service users were observed using all parts of the home and staff support was available when required. Information had been recorded in care files to provide staff with information about how best to support service users and which also identified long and short-term personal goals. This helps to ensure the skills and abilities of the people using the service are continually developed. The acting manager and staff continue to record and monitor all daily activities, achievements and progress. Examination of the (AQAA) confirmed Autism Initiatives had developed a policy on Sexuality and Relationships for people with Autism. Discussion with the acting manager and staff confirmed service users were encouraged to maintain contact with relatives and one service user was observed to receive a visit from two family members during the inspection. A budget of approximately £100.00 per week was available for food. A menu plan had been developed and records of each service users dietary intake was monitored and recorded in daily record books. Some gaps were noted and this should be kept under review. Service users were encouraged by staff to choose a healthy diet. Meals times remained flexible and unhurried to meet the daily routines of the people using the service. Some service users continued to require support during meal times and support was provided by staff in a sensitive manner as previously noted. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service receive ongoing support with their personal, health care and medication needs to ensure a healthy lifestyle. Evidence: Discussion with the acting manager, staff and relatives together with examination of records highlighted that the people using the service required different levels of support with their personal care. Staff spoken with reported that service users also required assistance to manage their health care needs. Each service users personal care and support requirements had been outlined in their personal files and staff spoken with demonstrated awareness of the physical, social and emotional needs of the people they cared for, together with the principles of good care practice and the need to promote privacy, dignity and independence. Records of personal care had been completed but some gaps in weekly recording were noted which were discussed with the acting manager. Summary records of the contact each service user had with medical and health care professionals was also available for reference. Records of appointments with dentists, doctors, chiropodists, community Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: nurses and psychiatrists were on file together with information on attendance at health clinics. It was noted that there was no information on optician appointments and this should be reviewed. One parent spoken with highlighted a concern regarding poor communication concerning changes to a service users medication. The relative confirmed that following a letter of complaint to the provider, action had been taken to resolve the matter. Examination of the Annual Quality Assurance Assessment (AQAA) for 12 Mount Avenue confirmed a corporate medication policy was in place to provide guidance to staff. None of the people using the service had responsibility for managing their own medication at the time of the visit. The acting manager reported that staff responsible for administering medication had completed in-house training via Autism Initiatives teaching unit in addition to on-site training. Medication was delivered in blister packs via a local pharmacist and securely stored in a locked cabinet. All received / returned medication was recorded and sample signatures and an identification system was in place to assist staff who administer. Information was also available for all staff on the side effects of the prescribed medication and the signs to be aware of. Appropriate storage and recording systems were in place for the administration of controlled drugs. Medication Administration Records for the three people living in the home were viewed during the visit. No issues of concern were noted regarding the recording of medication administered. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures and records for managing complaints and safeguarding incidents are in need of review to ensure best practice and to protect the welfare of service users. Evidence: The Annual Quality Assurance Assessment (AQAA) detailed that 12 Mount Avenue had a copy of the corporate complaints procedure for Autism Initiatives. At the time of the visit a copy of the procedure was not available in the Statement of Purpose / Service User Guide. The Acting Manager was able to locate a copy of a complaints procedure dated 28/05/2002 however this was not-up-date and required additional information. The AQAA detailed that two complaints had been received in the past 12 months. Examination of the complaint log for 12 Mount Avenue revealed that only one complaint had been recorded for this period. This concerned an anonymous phone call received by staff. The incident was referred to the Police and logged. The Care Quality Commission received notice of seven complaints, concerns or allegations in the last year. The nature of the concerns were as follows. Four related to the conduct of staff employed in the home, one concerned an incident in which a service user was involved and one was received from a relative and concerned poor communication about the welfare of a service user. Four of the incidents were referred to the local authority safeguarding unit for review and two were referred to the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Provider (Autism Initiatives) for investigation and action. A relative spoken with during the visit expressed concern regarding the length of time the Provider had taken to investigate and respond to a complaint and this should be reviewed. The Acting Manager was able to locate a copy of the local authority adult protection procedures, together with a copy of a Whistle blowing and a Service User Protection document developed by Autism Initiatives. The acting manager reported that the documents were not-up-to-date. Basic alert procedures had also been displayed in service users bedrooms for people to reference. The AQAA detailed that all staff received training in adult protection, attitudes and values and management of challenging behaviour (positive intervention). The acting manager provided a summary of training completed by the staff tam and this confirmed that the majority of staff had completed training in Safeguarding Adults. The acting manager and staff spoken with demonstrated a satisfactory understanding of the different types of abuse, reporting procedures and their duty to safeguard the welfare of vulnerable adults. The Registered Provider continues to have an adult protection officer in place and an advocacy service and / or relatives support is available should people require assistance. Care Homes for Adults (18-65 years) Page 20 of 32 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. Maintenance and cleaning arrangements within the home are in need of review to ensure service users benefit from a clean, well maintained and homely environment. Evidence: Riverside Housing Trust (The Landlord) is responsible for the general maintenance of 12 Mount Avenue however the Registered Provider (Autism Initiatives) has responsibility for some emergency repair work. Arrangements were in place for contractors to be hired for the servicing of equipment within the home and on the day of the visit a fire alarm engineer was observed to be on-site undertaking work. The acting manager reported that records were maintained for work in need of attention / completed but was not able to locate a maintenance plan for the ongoing refurbishment and maintenance of the premises. This should be developed to ensure best practice. A tour of the premises was undertaken during the visit. The ground floor of the accommodation comprises a spacious lounge, dining room, kitchen and wet room. There are three large bedrooms upstairs together with an office area and a bathroom. At the rear of the house is a private yard, which is paved and furnished for service users to use. All residents bedrooms were viewed and were found to be individually furnished, personalised and comfortable. The property has no adaptations or specialist Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: equipment. On the day of the visit the premises appeared to be maintained to a satisfactory standard however some issues were noted. For example, the wet room had signs of dampness and the toilet was cracked. The kitchen units were also in need of refurbishment and some areas of the home were in need of redecoration. Service users and staff continued to look after the cleaning of personal bedrooms and the communal parts of the home. Some issues of concern regarding the standard of cleaning in the home were discussed with the acting manager and staff during the visit. For example some of the kitchen units were stained and in need of cleaning and a vent in the kitchen was full of dust. A service users bedroom was also in need of more effective cleaning as some of areas of the floor surface and skirting were covered in dust. Other issues were noted during the inspection which were addressed by staff. Domestic style laundry facilities are available in the kitchen separate from the food storage area. All staff continue to be involved in the laundering of service users clothes and the people using the service are encouraged to participate in this task. Care Homes for Adults (18-65 years) Page 22 of 32 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. Records relating to the recruitment and training of staff are in needs of review to provide evidence that the welfare of service users is safeguarded. Evidence: The acting manager reported that 12 Mount Avenue had a team of seven support workers. At the time of the inspection there were three service users living in the property. Examination of rotas highlighted that the care home was usually staffed with a minimum of two staff during the day. At night one waking night staff was on duty. Discussion with the acting manager, direct observation and discussion with staff and relatives confirmed the staffing levels were sufficient to ensure the needs of service users were met. The Annual Quality Assurance Assessment (AQAA) detailed that the Registered Provider (Autism Initiatives) had a policy on recruitment, including redundancy and that pre-employment checks had been completed for all staff. The acting manager reported that six new staff and herself had commenced Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: employment in the home since the last visit. Only two files were available on the premises for inspection as the other files had not been transferred from head office. Files viewed contained application forms, two references and evidence that a protection of vulnerable adult and / or criminal record bureau check had been undertaken and training records and certificates. One file did not contain proof of identity or a medical declaration. Evidence of supervision sessions was available however the frequency of the sessions was in need of attention. Autism Initiatives continued to produce a learning and development plan every three months to ensure staff had access to a range of training and development opportunities relevant to their roles. This included specialised training in the care of people with autistic spectrum disorders and health and safety training. Due to the absence of staff files and documentary evidence of training completed, it was not possible to assess induction or the full range of training completed by staff. The acting manager had obtained a summary record of training completed by the staff team. Discussion with staff and examination of the training summary record confirmed that staff had access to a range of training. Some gaps in training were identified which should be addressed. The AQAA detailed that five of the seven support workers (71.4 ) had completed a National Vocational Qualification in Care at level 2 or above. Care Homes for Adults (18-65 years) Page 24 of 32 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. The management and administration of 12 Mount Avenue is in need of ongoing review to ensure staff and service users benefit from stable and consistent leadership, direction and support. Evidence: Examination of records and discussion with support staff and the new acting manager (Susan Hirst) revealed that 12 Mount Avenue has had no stable management since the death of the previous registered manager. Staff reported that the home had been managed by six acting managers to date and that the absence of a registered manager and consistent leadership was affecting the operation of the home in key areas such as staff morale, service paperwork and cleaning duties etc. The new acting manager reported that she had transferred to 12 Mount Avenue during March 2010 from another home within Autism Initiatives, pending the appointment of a permanent replacement. The acting manager advised that she had worked for Autism Initiatives since March 2006 and that she had recently completed a National Vocational Qualification (NVQ) in Health and Social care, which was awaiting Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: verification. The acting manager also highlighted that she did not have a relevant qualification in management but confirmed she had completed all mandatory training relevant to her role. It was not possible to verify any of the information provided by the manager as a recruitment file and training record were not available for reference. The acting manager demonstrated a commitment to developing the service provided at 12 Mount Avenue and to providing staff and service users with the support and / or direction they required. Staff and relatives spoken with were unable to provide detailed feedback on the manager due to the short period of time she had managed the home but all highlighted the need for a permanent manager. Autism Initiatives continued to employ a quality assurance coordinator who was responsible for inspecting the home on an annual basis. The most recent report could not be located but a quality assurance plan dated 6/08/08 was available for reference. Evidence of Regulation 26 reports were also on file. The most recent was dated 9th February 2010 and had been completed by one of the previous acting managers of 12 Mount Avenue. A financial audit had also been completed during 4th February 2010. A Quality Network team is also in operation which involves representatives from all involved in the care and support of service users. Previous inspection reports detail that the group meets regularly to discuss residents rights, outcomes and new developments. A parent of one of the residents remains a representative on the board of trustees. The AQAA detailed that equipment in 12 Mount Avenue had been routinely serviced and maintained however the date of the last electrical wiring, heating and gas safety certificates had not been recorded. A certificate for the gas and heating was located during the inspection however a certificate to confirm the electrical wiring installation was safe could not be located. Fire safety records were viewed during the visit. Service certificates were on file to confirm that the fire alarm system and extinguishers had been periodically serviced. Records could not be located to confirm the weekly testing of the fire alarm or monthly testing of the emergency lights or visual inspection of the fire extinguishers. The last fire instruction record was dated 28/04/09 however there were no details of which staff had completed the training or their designation. A brief fire risk assessment was in place which was not dated. A building risk assessment could not be located. The acting manager reported that all hot water outlets were fitted with temperature valves but no temperature check records could be Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: found. The AQAA detailed that a range of policies and procedures were in place for staff to reference. Some review dates were missing and some policies viewed during the visit were in need of review. Staff spoken with reported that they had access to health and safety mandatory training as part of their role. Some gaps were noted and this was raised with the acting manager. Care Homes for Adults (18-65 years) Page 27 of 32 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 32 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 1 34 19 Records relating to the 14/06/2010 recruitment and training of staff must at all times be available for inspection at 12 Mount Avenue. This will provide evidence that staff are appropriately recruited, inducted and trained for their roles and confirm the welfare of service users is safeguarded. 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 42 23 The fire alarm must be 14/06/2010 tested on a weekly basis and the emergency lights on a monthly basis and records maintained. This will safeguard the health and safety of service users and staff. 2 42 23 A certificate must be obtained for the electrical wiring installation. This will help to verify that the electrical wiring installation for 12 Mount Avenue is safe. 14/06/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 1 The Statement of Purpose should be updated to include all the information outlined in Schedule 1 of the Care Home Regulations 2001 and the Service User Guide should be updated to meet the criteria detailed in Regulation 5. This will ensure that people using the service and / or their representatives have access to all the necessary information on the service. All outstanding records relating to the care of service users should be brought up-to-date and and more efficient systems should be established to ensure records are correctly completed. Visual resources and picture communication systems should be established to assist service users and staff to communicate more effectively. Optician appointments should be recorded and / or arranged to confirm the service users have their vision checked periodically. Records of all complaints, concerns and / or or allegations received together with the action taken and outcomes should be logged and available for reference at 12 Mount Avenue. Action should be taken to ensure any complaints received are investigated and responded to within 28 days to ensure compliance with the Care Home Regulations 2001. An up-to-date copy of the Registered Providers Complaint, Whistleblowing and a Service User Protection procedures should be obtained for staff to reference. The kitchen units and cracked toilet should be repaired / replaced as soon as possible. A plan for the ongoing refurbishment and maintenance of the premises should be developed to ensure best practice. Cleaning schedules should be reviewed and closely monitored to ensure the premises is kept clean and hygienic at all times. The registered provider should appoint a permanent manager to 12 Mount Avenue as a matter of priority and ensure a registration application is forwarded to the Care Quality Commission without delay. Page 30 of 32 2 6 3 7 4 19 5 22 6 22 7 22 8 9 10 24 24 30 11 37 Care Homes for Adults (18-65 years) 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 12 13 42 42 The fire risk assessment should be revised and dated to ensure safe working practices. The temperature of all hot water outlets should be tested and recorded on a monthly basis to confirm the temperature is limited to 43 degrees centigrade. Day staff should complete fire instruction training at least every six months and night staff every three months and records maintained of the date of the training, the name of staff and their designation. The fire extinguishers should be visually inspected on a monthly basis and records maintained. 14 42 15 42 Care Homes for Adults (18-65 years) Page 31 of 32 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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