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Inspection on 19/04/10 for Park Avenue 4

Also see our care home review for Park Avenue 4 for more information

This is the latest available inspection report for this service, carried out on 19th April 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Park Avenue is a comfortable and well-managed home that provides a high standard of care for people with a range of complex needs. The home makes a concerted effort to ensure compliance with requirements issued by the CQC. People generally appear happy and well cared for and at ease with staff members supporting them. The majority of staff at the home have been employed there over many years. The low staff turnover helps to give residents a sense of stability and reassurance as their routines are not constantly disrupted by new staff. The living environment is decorated and furnished appropriately, and people living at the home are able to choose the decor of their own rooms and personalise them according to their tastes. Comprehensive care plans and risk assessments are available for all people living at the home, and a range of appropriate activities are available both inside and outside of the home. People are also supported to go on holiday at least once a year and to maintain contacts with their family and friends. Staff have detailed guidelines, drawn up with the support of psychologists, for understanding and addressing challenging behaviours expressed by people living at the home. Pictorial aids are used effectively to meet the communication needs of individual people living at the home. A varied menu is available for residents, with choices to meet their individual and cultural preferences. The home is flexible at supporting people to assist in tasks of daily living including setting the table, cooking and clearing up. One person, who has more advanced independent living skills, is supported to cook independently. The home supports residents to develop independent living skills, and one current resident advised that they are planning to move on into more independent accommodation, with support from the staff team. Staff undertake a variety of relevant training courses as appropriate. There is a good rapport between people living at the home, management and staff. The manager at the home has been in post since the home first opened and the home continues to benefit from her management.

What has improved since the last inspection?

As recommended a simplified care planning system had been put in place, so that important information can be found easily. A number of minor repairs were made as specified in the toilets and bathrooms within the home, for the comfort of residents. Staff training certificates were available for training completed and further staff members had completed training in first aid, manual handling and fire safety. Further staff have completed National Vocational Qualification training to level 2 or above, to ensure that they work in the best interests of people living at the home. The fire risk assessment was being reviewed regularly as required, for the safety of staff and residents. The provider organisation had obtained `Investors in People` and a quality management accreditation, to ensure a high quality of service to residents and support for the staff team.

What the care home could do better:

As is currently planned, residents would benefit from a more varied selection of activities in line with their preferences and needs. Some further improvements are required within the building, as outlined in the home`s refurbishment plan, these include maintenance of the back garden, repair of the second floor shower and toilet rooms, redecoration of the front of house, and replacement of the kitchen units and surfaces. It is recommended that sexuality training be provided to the staff team to ensure that they can support residents appropriately, and that the systems for recording monies and valuables taken out on behalf of residents be improved, to further protect residents and staff. Staff must ensure that the temperatures of all refrigerators and freezers are checked on a regular basis, and that current electrical installation and legionella certificates are available for the home, to ensure the safety of people living and working at the home. The current electrical installation for the home was located shortly after the inspection, and the manager advised that a new electrical installation inspection was undertaken on 7th May 2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Park Avenue 4 Park Avenue 4 Wood Green London N22 7EX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Shamash     Date: 1 9 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: Park Avenue 4 Park Avenue 4 Wood Green London N22 7EX 02088885055 02088886785 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hoffman Foundation for Autism Name of registered manager (if applicable) Ms Sharon Diana Martin Type of registration: Number of places registered: care home 6 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 4 Park Avenue is a registered care home owned by the Hoffman Foundation, a voluntary organisation that provides services to meet the needs of people with learning difficulties who may also have autistic spectrum disorders. The home is a large converted house with six bedrooms on the first and second floors and the main communal areas on the ground floor. The premises are not suited to meet the needs of people with significant mobility disabilities. 4 Park Avenue is walking distance to Wood Green shopping centre and a range of public transport links. Hoffman Foundation for autism also provides a separate day service provision in the adjoining premises. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home The stated aim of the home is to provide high quality residential service for up to six people with learning disabilities and characteristics that may fall within the autistic spectrum. The range of fees for the home, as at April 2010 range from 1153.85 - 2057.69 GBP depending on level of need. Copies of the most recent CQC inspection reports can be obtained from the office at the home or from www.cqc.org.uk (the CQC website). 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection lasted approximately six and a half hours. The registered manager was present for the majority of the inspection and I was also assisted by other members of the staff team. At the start of the inspection, three residents were attending a day centre, two went out with staff members shortly after my arrival, and one person remained in the home, having been shopping that morning. During the course of the inspection, people arrived back from day activities. I was able to speak to one person in detail and spent time with the five other residents in the presence of staff members in the kitchen, lounge and dining areas. I also had the opportunity to speak with five staff members briefly during the inspection. The visit was undertaken as a routinely scheduled inspection of the home and to monitor compliance with matters identified at the previous inspection. A tour of the Care Homes for Adults (18-65 years) Page 6 of 32 building was conducted, and three care plans, four staff files in addition to a range of other records maintained at the home, were inspected. A completed current Annual Quality Assurance Assessment was provided to CQC as appropriate, and completed surveys were returned by six staff members and six people living at the home (completed with assistance from staff members). Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? As recommended a simplified care planning system had been put in place, so that important information can be found easily. A number of minor repairs were made as specified in the toilets and bathrooms within the home, for the comfort of residents. Staff training certificates were available for training completed and further staff members had completed training in first aid, manual handling and fire safety. Further staff have completed National Vocational Qualification training to level 2 or above, to ensure that they work in the best interests of people living at the home. The fire risk assessment was being reviewed regularly as required, for the safety of Care Homes for Adults (18-65 years) Page 8 of 32 staff and residents. The provider organisation had obtained Investors in People and a quality management accreditation, to ensure a high quality of service to residents and support for the staff team. What they could do better: 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed pre-admission information is available for people to ensure that their needs are fully assessed and can be met effectively. Evidence: The home is registered for six people all of whom have lived at the home for several years. The most recent person moved into the home in 2003. Detailed assessments were available for each person from which care plans had been developed. The manager remains very aware of the need to obtain pre-admission information before any new person was admitted to the home, and confirmed that appropriate admission procedures were in place. The manager and a psychologist carry out an initial assessment to ascertain if a service can be provided to meet prospective residents needs, following which a comprehensive support plan is produced, including guidelines and risk assessments. A comprehensive transition plan is then put in place, which remains flexible according to the persons needs. A service user guide is provided to each new resident. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: The manager advised that since the previous inspection the service has gained a quality assurance management accredition (ISO 9001:2000) and improved in-house psychology support for people living at the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes care plans, guidelines and risk assessments have been reviewed recently to ensure that they are easy to follow and reflect peoples current needs in detail. Peoples wishes regarding their care are sought consistently, and they are involved as far as possible in all aspects relating to life at the home, for which the home is commended. Following assessments, people are supported to take appropriately safeguarded risks and to develop independent living skills. Evidence: Three peoples files were examined in detail. Each contained detailed care plans with evidence that they had been reviewed within the last six months. Files also contained guidelines and risk assessments on particular areas of need or concern e.g. dealing with challenging behaviour. As recommended, the recording system for care plans, risk assessments and Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: guidelines for support of people living at the home, had been reviewed to create a simpler system that was easier to follow. More detailed information had also been provided in the guidelines and risk assessments. Files also contained person centred plans including useful information about peoples needs and wishes obtained through close consultation. Information in these plans indicated that peoples wishes and decisions relating to all aspects of their care had been taken into account as far as possible, with staff adapting to peoples changing needs, liaising with family members, and advocates. The majority of people living at the home have limited levels of verbal communication and some were reluctant to speak to me. However I was able to have a chat with one person and to spend some time with the other residents. One person told me that they were well supported by staff at the home and they were encouraged to be independent in areas that they were able to e.g. in cooking. They advised that they were currently being supported to move to a more independent care setting. All residents are encouraged to make choices about their daily activies, clothing, food they like to eat etc. Daily logs recorded residents involvement in making choices, as did review meeting minutes and records of advocacy input. Observation of staff interacting with people living at the home indicated that they continued to have a good rapport with people living at the home, and were very knowledgeable about their individual needs. This included skillful and sensitive responses to residents exhibiting challenging behaviour. Risk assessment information was specific to each person and their needs, including risks within the home and outside. Picture boards were being used for each person to plan their day ahead and communicate choices to staff. I witnessed people using the picture boards and other communication methods successfully, and the home is commended for the effective use of such communication tools. The manager advised that there were plans for the service to obtain training and support from the speech and language team to develop more communication formats to support people to express their needs and choices. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home supports people living at the home to engage in a variety of educational, leisure and daily living activities of their preferences both within the home and in the community for which it is commended. They are encouraged to maintain positive relationships with their family members and friends, and their rights and responsibilities are respected. Peoples dietary needs and tastes are well catered for by the home and menu options are presented in a pictorial format that encourages them to make informed choices on what they would like to eat. Evidence: Daily notes recorded for people living at the home included details of a variety of activities that they are involved in. I saw daily shift plans that list the names of all the Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: staff on duty and the work or activities that they are to undertake with individual people living at the home. If the activity does not take place, staff record the reasons why and any alternatives offered. The information in the daily shift plans are linked to the information contained in each persons weekly activities programme tailored to individual tastes and reviewed when there are changes. Activities recorded included cooking, visits to the local park, arcades, the library, day centres and discos, car boot sales, family visits, eating out, shopping, swimming, knitting, pub visits, cinema trips, playing computer games and drives in the homes van. Staff and a person living at the home advised that regular contact with friends and family is encouraged, and this was confirmed by daily care records and records of visitors to the home. On arrival at the home three residents were at home, with two of them about to go out within the local community, and the other resident cooking their breakfast with supervision. A further resident returned home later that morning, having been out on a trip in the local area with two staff members supporting them, as recorded in their care plan. Other service users returned from a day at the day centre later in the afternoon. Residents spoken to, and those I spent time with, indicated that they had enjoyed their daytime activities and were able to engage in activities of their choices on returning to the home. The manager advised that the home is in the process of reviewing the activities for residents, to provide them with an increased variety of activities, and the opportunity to change to new activities according to their preferences. Trampolining had already been identified as a new activity for at least one resident, and a placement at a local farm was being researched for another person. One person had joined a local community group, recently participating in a boat trip, and art studios were available at the day centre next door, for people wishing to use them. No residents currently attend college facilities, but in the past two residents have attended courses including a computer course, photography and hair and beauty courses. A computer is available in the lounge for the use of people living at the home. Two residents go to the cinema on a regular basis, and records noted that they had been to see current popular films including Kick-Ass, Alice in Wonderland, the Spy Next Door, and Shutter Island. Residents generally go on at least one holiday each year, there are also trips arranged to the seaside and other places of interest during the year. A forthcoming holiday in May, was planned for a number of residents in Bognor Regis. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Care plans indicated that people living at the home are encouraged to be involved in household tasks such as preparing meals and cleaning and tidying the house and observation of activities in the home confirmed that this was the case. The home uses communication boards where pictures are used to show the activities that people will be involved in, on a daily basis. The home has a 4-week set menu (with picture aids) and staff advised that individuals have the opportunity to take it in turns to make meal choices for everyone. People who do not like the meal selected still have the option to make their own choices. I observed people eating snacks and their evening meal at the home, confirming that staff were very aware of their preferences. All appeared to eat well and enjoy their meals. Meal choices included cultural alternatives to meet the preferences of AfroCaribbean residents, and staff advised that these meal choices are in fact enjoyed by all residents. On the evening of the inspection all residents appeared to enjoy the dinner of Jollof rice with lamb chops. Care Homes for Adults (18-65 years) Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home receive a high standard of support with both physical and emotional health needs according to their needs and preferences, and detailed guidelines are available to support them, for which the service is commended. The home has stringent medication practices and safeguards as appropriate to minimise potential risks to people living at the home. Evidence: Three residents files were inspected including detailed information about peoples physical, emotional and social needs as appropriate in the form of care plans, guidelines and risk assessments. These indicated a high level of psychologist support regarding guidelines for addressing challenging behaviour, for which the service is commended. Daily records, discussion with staff and residents, in addition to observation of interactions within the home indicated that peoples needs are being addressed appropriately, with their preferences and choices kept in mind. Information was available regarding all GP, hospital and healthcare appointments as appropriate, Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: indicating that regular contact is maintained with health care professionals, in line with peoples needs. There are no people self-administering medication at present. Inspection of staff training certificates and a staff training matrix produced by the manager indicated that some staff members need updated training. All staff administering medication have had training by the local pharmacist in the use of the NOMAD system. Some but not all staff working in the home have received external training in the administration of medication. Medication received at the home is checked and signed in by staff to ensure that it is correct. There is also a weekly check carried out by a member of staff to ensure that medication practices are being followed appropriately. Temperatures are maintained within the required range in the area where medication is stored. Medication administration records inspected were completed appropriately by staff. Use of PRN (as and when) medicines appeared to be appropriate, and the reason for administration was being recorded on the medication administration records (MAR sheets). Guidelines for the use of PRN medication for challenging behaviour, were available within peoples care plans, and staff did not administer this without seeking advice from on call management support. However staff noted, and records confirmed that PRN medication for residents relating to behavioural issues, was very rarely administered. Instead detailed guidelines were in place regarding de-escalating anxiety provoking situations. Care Homes for Adults (18-65 years) Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Regular residents forums, and consultation with family members and advocay services ensure that people living at the home have a formal channel through which their concerns can be expressed and resolved. Appropriate procedures are in place and most staff have been trained in safeguarding adults to ensure that people are protected from abuse. Evidence: Where complaints are recorded, evidence is available that appropriate action has been taken to address the concerns raised. An appropriate record of complaints is maintained indicating action taken within appropriate timescales. The manager confirmed that the provider organisation continues to hold service user forum meetings periodically to facilitate peoples involvement in the running of their services. In addition advocacy from family members, friends and other healthcare professionals is encouraged, particularly for non-verbal residents, providing a forum where issues of concern can be discussed and addressed. The manager noted that it continues to be difficult to arrange resident forums within the home due to the different needs and abilities of each person, but informal arrangements were in place for seeking their views on a regular basis. Staff spoken to confirmed this as did entries recorded within peoples care plans and daily notes. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Some certificates were available evidencing that staff members had received safeguarding adults training as appropriate, and the manager was aware of staff members who needing updated training in this area, as recorded on the training matrix for the home. The home has a good track record of processing safeguarding issues appropriately in line with local authority guidelines. Care Homes for Adults (18-65 years) Page 21 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. The home environment is comfortable, clean and safe and is generally in a reasonable state of repair and decoration. People living at the home have personalised their bedrooms and have adequate toilets and bathrooms to meet their individual needs. A small number of repairs and redecoration are required to ensure that they continue to live in a safe and comfortable environment. Evidence: The home is comfortable and safe although generally sparsely decorated, due to the needs of some of the people living at the home. People living at the home are able to decorate their rooms according to their tastes. I was able to view the majority of peoples rooms, and was told that all people living at the home had chosen the colour schemes for their rooms. One person who is planning to move into more independent accommodation, advised that they liked their room, it was comfortable and decorated in their colour of choice. Since the previous inspection a new hifi system and a large flat screen television had been purchased for the lounge, with Sky television provided. A new dishwasher and cooker head had been fitted, and new garden furniture was procurred. The home was clean with no unpleasant odours despite some people being Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: incontinent. A domestic worker is employed to support the remaining staff in keeping the home clean and hygeinic. Waking night staff also carry out cleaning tasks according to a shift planning system. Sluicing facilities are available in the laundry room and sanitary bins within the communal bathrooms. Protective clothing including gloves and aprons are provided for staff members. The home has a large garden at the rear, which was in need of some maintenance, but included appropriate garden furniture for the comfort of people living at the home. One resident chose to sit out in the garden area to have their evening meal, and appeared to enjoy the garden environment. Staff confirmed that residents used the garden frequently with risk assessments in place for the level of supervision each person needed when using this area. Given the nature of some peoples disabilities, I noted that there were relatively few repairs required within the home. The repairs required at the previous inspection had been undertaken. The home has a rolling maintenance and redecoration plan so that all areas of the home are redecorated periodically. Last year the hallway, lounge and kitchen were repainted, and new carpet and flooring were provided. The second floor shower and toilet were in need of repair (these were kept locked at the time of the visit), the back garden needed some maintenance, the front exterior of the home was in need of redecorated, and new units/surfaces needed to be provided in the kitchen. It is also recommended that the ground floor toilet and shower rooms be redecorated, so that these are more inviting for people living at the home. The homes maintenance plan confirmed that these items had been prioritised, alongside redecration of the homes laundry room and bathrooms. Care Homes for Adults (18-65 years) Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriately experienced and qualified staff support people effectively according to their individual needs. Stringent recruitment practices and frequent staff supervision are in place to ensure the protection of people living at the home as far as possible. The home has identified training needs for each staff member, so that these can be provided to ensure that peoples needs are met in line with best practice at all times. Evidence: Staff on duty in the home reflected those recorded on the homes rota, and those spoken to indicated that sufficient staff were generally on duty to meet residents needs safely. No agency staff are used by the home, instead the provider organisation has a bank of relief workers, who work at the home on a regular basis. Team meetings are held fortnightly and inspection of meeting minutes indicated that these cover a range of subjects relevant to residents welfare and the smooth running of the home. Four staff files were inspected and these were found to include satisfactory enhanced CRB disclosures, references, identity documents and all the other information required Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: as specified under Schedule 4 of the Care Homes Regulations 2001. Inspection of staff supervision records indicated that this was occurring regularly. The home aims to provide individual staff members with supervision approximately monthly. Staff members spoken to confirmed that they received strong support and supervision from the management. Staff files included certificates of relevant training courses undertaken by staff including health and safety, food hygiene, autism awareness, working with challenging behaviour, breakaway techniques, Makaton, person centred planning and epilepsy. Staff spoken to advised that training provided was useful and relevant. Over fifty percent of staff members had obtained an NVQ (National Vocational Qualification) in care at level 2 or above, as appropriate. A training matrix, recording training undertaken by each staff member was available for the home so that training needs could be targeted easily. New staff members had been provided with induction training at head office prior to commencing work at the home. The provider organisation have gained recognition as an Investor in People. The manager advised that training updates, were to be provided for several staff members in safeguarding adults, medication administration, first aid, health and safety, autism, and fire safety in the coming year. It is recommended that sexuality training be provided to staff living at the home, as highlighted in the care plan for one resident, to enable them to provide sensitive support to people living at the home in this area. Care Homes for Adults (18-65 years) Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed proficiently to ensure that peoples needs are met appropriately. There are effective quality assurance procedures to ensure that peoples preferences are taken into account and that the standard of care and support remains high. Residents best interests are safeguarded by the homes record keeping procedures. The health and safety of staff and people living at the home is generally protected appropriately, although there is room for improvement in a small number of areas. Evidence: The registered manager is appropriately qualified and experienced, and has undertaken the Registered Managers Award at NVQ level 4 as appropriate. Discussion with the manager, individual staff members and one person living at the home indicated that the manager continues to be very knowledgeable about the needs of people living at the home, and provides a very high standard of support to staff and residents. Since the previous inspection the provider organisation have also introduced an employee assistance programme, offering confidential advice and counselling. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: The home has effective recording and checking procedures to safeguard residents finances as appropriate, with all amounts checked at the end of each shift. The finances of two people living at the home (one in detail) were checked during the inspection, and appeared to be in order. However there is no current recording system for property kept for safekeeping in the homes safe e.g. passports, bank books, freedom passes etc. It is recommended that these should be signed in and out of the home. There is also room for improvement in the recording of monies taken out of the home prior to the receipt and change being brought back, (currently a post-it note is left for other staff members) to provide further protection for both staff and residents. Staff meetings are held regularly and minutes indicated that staff are encouraged to express their views about the running of the home. A detailed quality assurance audit had been undertaken for the home as appropriate, and regular unannounced visits are undertaken by the provider organisation to the home on a monthly basis as appropriate. The home have gained ISO 9001:2000 accreditation (a quality management award), and an annual development plan is produced for the service. The annual quality assurance assessment was completed appropriately, providing important information about the home. A different staff member is assigned the responsibility of completing a health and safety check list each week. Fire alarms were being tested weekly as appropriate, and there was evidence that fire drills were being held regularly. Appropriate gas, and portable appliances testing certificates were available for the home. Although appropriate thermostatic valves had been fitted to hot water outlets, the temperature of hot water from all outlets in the home was being monitored on a regular basis and recorded. The manger was unable to locate the current legionella and electrical installation certificates at the time of the inspection, and a requirement is made accordingly. The electrical installation certificate was located shortly after the inspection, and the manager advised that a new electrical installation inspection took place at the home on 7th May 2010. A detailed fire risk assessment was available for the home, and this had been reviewed within the last six months. However there were gaps in the records of refrigerator and freezer temperatures within the home, due to two thermometers having gone missing. A requirement is made accordingly. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 24 23(2bd) The registered persons must 22/06/2007 ensure that the board under the bath in the 2nd floor bathroom be repainted, The ground floor shower, ceiling ring must be replaced, The adjoining toilet water tank top must be replaced. The bin lid in the laundry must be repainted, and the issue of cracks on the ceiling of the laundry room must be addressed. 2 35 18(1ci) The registered persons must 24/08/2007 ensure that staff training certificates are available for all training completed and all staff members complete training in first aid, manual handling and fire safety. The registered persons must 08/06/2007 ensure that an annual legionella test is carried out for the home (Previous timescale of 06/10/06 not met) and the fire risk assessment is reviewed at least sixmonthly. The manager advised that these were addressed shortly after the Page 28 of 32 3 42 13(4a) Care Homes for Adults (18-65 years) 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 inspection. Care Homes for Adults (18-65 years) Page 29 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 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 24 23 The registered persons must 24/09/2010 ensure that the second floor shower and toilet are repaired, the back garden is maintained, the front exterior of the home is redecorated, and new units/surfaces are provided in the kitchen in accordance with the homes maintenance plan, for the comfort of people living at the home. . 2 42 13 The registered persons must 28/05/2010 ensure that the temperatures of all refrigerators and freezers within the home are checked at least daily and that this is recorded, to ensure the safe storage of foods within the home, and that a current electrical installation certificate and legionella testing certificate is Page 30 of 32 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 maintained within the home for the protection of residents. . 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 24 It is recommended that the ground floor toilet and shower rooms be redecorated, so that these are more inviting for people living at the home. It is recommended that sexuality training be provided to staff living at the home to enable them to provide sensitive support to people living at the home in this area. It is recommended that the system for recording properties and monies taken out by residents/staff members on behalf of residents, should be improved, to provide further protection for both staff and residents. 2 35 3 41 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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