Inspection on 12/05/08 for Limetree Avenue Care Home

This inspection was carried out on 12th May 2008.

CSCI found this care home to be providing an Good 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

Limetree Avenue Care Home 22/08/07

Limetree Avenue Care Home 30/05/06

Limetree Avenue Care Home 25/01/06

Limetree Avenue Care Home 30/11/05

Limetree Avenue Care Home 15/02/05

Limetree Avenue Care Home 15/07/04

Limetree Avenue Care Home 16/03/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Limetree Avenue Care Home 23 Limetree Avenue Retford Nottinghamshire DN22 7BB Lead Inspector Jayne Hilton Unannounced Inspection 12th May 2008 02:30 Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Limetree Avenue Care Home Address 23 Limetree Avenue Retford Nottinghamshire DN22 7BB 01777 708 725 F/P 01777 708 725 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.mencap.org.uk Royal Mencap Society Vacant-Acting Manager Sarah Hall Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2007 Brief Description of the Service: 23 Limetree Avenue is a 3-storey, semi-detached house in a quiet, residential street within quarter of a mile of Retford town centre, near shops, pubs, and cinema and leisure facilities. The home caters for six male and female residents with learning disabilities. It was established in 1991 and five of the residents have been there since that time. The latest addition arrived in 1996; no one has been admitted since. Five of the current residents attend local authority day care services for some part of the week. All residents have their own personalised decorated bedrooms, with a communal lounge, dining room and kitchen. There is a bathroom and a shower room; there are toilets on each floor. One ground floor bedroom is en-suite. There is a small well - maintained garden. On the second floor there is a sleepin room for staff and an office where records, documents, policies and procedures are kept. Detailed information was not provided about fees, but the manager stated these are dependent on individual assessed needs. A Statement of Purpose and Service user guide was on display in the home on the day of the inspection and a copy of the Inspection report was available on request. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live in the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 3.5 hours and was unannounced. The main method of inspection used was called ‘case tracking.’ This involves selecting one person and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading residents’ records and documents. Comments from three people living in then home, one visiting professional and three staff were obtained from pre inspection surveys issued prior to the inspection. Three members of staff and the acting manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided. The Annual Quality Assurance Assessment document was received on the day of the inspection and has been used to assess the service also The quality rating for this service is 2 Star. This means the people who use this service experience Good quality outcomes. What the service does well: Significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 6 The home has developed a comprehensive statement of purpose and service user’s guide, which is very specific to the resident group and considers the different styles of accommodation, support, treatment, philosophies and specialist services required to meet the needs of people who use the service. The information is in a format suitable for their and their families’ needs, using, for example, appropriate language, pictures or Braille. All new residents receive a comprehensive needs assessment before admission. This is carried out by staff, with skill and sensitivity. The service is highly efficient in obtaining a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of the care plan before admission. For individuals whom are self funding, the assessment is undertaken by a highly qualified member of staff. Individuals are supported and encouraged to be involved in the assessment process. Information is gathered from a range of sources including other relevant professionals, and with the individuals agreement, carer’s interests are taken into account. The assessment focuses on achieving positive outcomes for people and this includes ensuring that the facilities, staffing and specialist services provided by the home meet the ethnic and diversity needs of the individual. The six strands of diversity are: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Prospective residents are given the opportunity to spend time in the home. An individual member of staff is allocated to give them information and special attention to help them to feel comfortable in their surroundings and enable them to ask any questions about life in the home. The key principle of the home is that people using the service are in control of their lives and they direct the service. Staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own informed decisions and have the right to take risks in their daily lives. The care plan is developed with, and owned by the person using the service. It is based on a full and up to date holistic assessment. It includes reference to equality and diversity and clearly addresses any needs identified in the six strands of diversity, which are: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. The plan is person centred and focuses on the individual’s strengths and personal preferences. The plan is written with the individual, or their representative, and includes a range of information that is important to them. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 7 People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. Staff in the home, are trained, skilled and in sufficient numbers, to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a competent manager. What has improved since the last inspection? The safety and lifestyle choices of people living in the home have been improved by the increased staffing levels currently provided. The garden paving has been re-levelled and made safe. Windows restrictors have now been adjusted to the safe opening limit. The ‘five yearly’ electric circuit test certificate has been renewed. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: A statement of purpose and service user guide was avialable in the home and contained picture and symbol formats to assist people with learning disabilities to access them. The acting manager stated in the AQAA [Annual Quality Assurance Assessment]: ‘As a service provider organisation, we place great importance on supporting people and their families in making an informed choice about where and how they live. We have policies and processes that guide staff in ensuring that people receive good and reliable information before they move and are supported in making a successful transition. We have an assessment process that involves gathering information from the person we are supporting, people who are important to them and any other professionals involved in their support (including assessments completed by Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 11 care management). Our Families’ Charter clearly outlines the way in which we wish to work with families in the best interests of the person we are supporting and directs us to share information and insights to help us meet an individual’s needs. We also recognise the importance of carefully reviewing that someone’s needs can be met by the service and once we are providing a service to someone we have regular planned reviews to address any issues or changes that have been identified.’ Assessment documentation was in place for the person ‘case tracked’ and person centred plans were devised from these and any ongoing assessments and reviews. Staff, were observed to communicate effectively with people during the inspection and were able to demonstrate verbally and through person centred planning that any cultural or religious needs of individuals were catered for. The acting manager stated in the AQAA, ‘ Diversity is one of Mencaps key strategic priorities. We have developed policies and processes to ensure that both in our recruitment and our service delivery, diversity is promoted. Mencap monitors the diversity of its workforce and the diversity of the people we support. On our intranet site we have a dedicated diversity section, this is accessible to all staff. The intranet site includes useful facts and figures for staff, together with practical information to assist staff in their work. Mencap has a dedicated diversity officer and there is a steering group of staff from across the organisation who, meet to share good practice and oversee the implementation of our diversity policy. As a service provider organisation, Mencap has a diversity policy that clearly states that people are treated fairly and no-one is treated badly because of something that is different about them. We welcome the differences in people and this is why we tailor support around a person’s unique needs and wishes. Our policies and processes in recruitment, training and service delivery encourage us to focus on how diversity can enhance the way we support people. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: The key principle of the home is that people using the service are in control of their lives and they direct the service. Staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own informed decisions and have the right to take risks in their daily lives. The care plan is developed with, and owned by the person using the service. It is based on a full and up to date holistic assessment. It includes reference to equality and diversity and clearly addresses any needs identified in the six strands of diversity, which are: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 13 The plan is person centred and focuses on the individual’s strengths and personal preferences. The plan is written with the individual, or their representative, and includes a range of information that is important to them. This could be information such as who and what is important to them, how they keep safe, their goals and aspirations, their skills and abilities, and how they make choices in their life. Plans are all different and highly individualised and they include evidence that the service values improving outcomes for people using the service. A variety of different and creative methods are used to help people who use the service to contribute to the development of their care plan and the ongoing review process. Staff have the specialised training and skills to support, engage and encourage the individual to be fully involved. Key workers actively provide one to one support, keep the care plan up to date and make sure that other staff always know the person’s current needs and wishes. The service knows and records the preferred communication style of the individual, and will use new and innovative methods that enable the person to fully participate. This could include communication charts, information about communication styles (sometimes called communication passports), relationship circles, intensive interaction, objects of reference, photographs, visual timetables, drawing and signing or symbols. The plan is an up to date working tool used by the individual and all involved staff. The care plan can be easily used by people who are not familiar with the individual to deliver a personalised and consistent person centred service. Plans are reviewed regularly, and as the individual’s needs change. The care plan includes a comprehensive risk assessment, which is regularly reviewed. The service has a ‘can do’ attitude and risks are managed positively to help people using the service lead the life they want. Any limitations on freedom, choice or facilities are always in the person’s best interests. The individual understands and agrees any limitations; they are fully documented and reviewed regularly. People using the service know, and are able to see, the records the home holds about them. Individuals know their rights and advocacy services are encouraged to promote these. People living in the home are continually consulted on how the service runs and are able to influence key decisions in the home whatever their communication style. They are fully involved in decisions about the areas such as staff selection, the day-to-day life of the home, and its future development. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 14 The home acts upon the results of consultation with residents and their representatives. The home makes sure that good practice is modelled and developed throughout. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: Central to the home’s aims and objectives is the promotion of the individual’s right to live an ordinary and meaningful life, appropriate to their peer group, in both the home and the community, and to enjoy all the rights and responsibilities of citizenship. The home understands the importance of enabling younger adults to achieve their goals, follow their interests and be integrated into community life and leisure activities in a way that is directed by the person using the service. The service understands and actively promotes the importance of respecting the human rights of people using the service, with fairness, equality, dignity, Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 16 respect and autonomy all being seen as central to the care and support being provided. People living in the home are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Routines are very flexible and residents can make choices in major areas of their life. The routines, activities and plans are person centred, individualised and reflect diverse needs. The service actively encourages and provides imaginative and varied opportunities for people using the service to develop and maintain social, emotional, communication and independent living skills where appropriate. The service has very strong and highly effective methods, which focus on involving residents in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. This includes developing and maintaining family and personal relationships. The service actively supports people to be independent and involved in all areas of daily living in the home. This includes where appropriate, taking responsibility for shopping, planning meals, and meal preparation. Good practice may include individuals being supported to be independent in the process following training and support. Meals are very well balanced and highly nutritional and cater for varying cultural and dietary needs of residents. For those individuals who need support during mealtimes, including those who have difficulty swallowing or chewing, staff give assistance. They are discrete and sensitive to the feelings of both the person they are helping and also to others present. Mealtimes are flexible and relaxed, staff are patient and helpful, and allow individuals the time they needed to finish their meal comfortably. Residents appreciate support and guidance about a balanced health diet. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: People living in the home receive effective personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Individual plans clearly record people’s personal and healthcare needs and detail how they will be delivered. Practices in the home reflect residents’ needs under the six strands of diversity. Staff ensure that care is person led, personal support is flexible, consistent, and is able to meet the changing needs of the residents. Staff respect people’s preferences and have expert knowledge about individual personal needs when providing support, including intimate care. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 18 Staff respond appropriately and sensitively in all situations involving personal care, ensuring that it is conducted in private and at a time and pace directed by the person receiving the care. Aids and equipment are provided to encourage maximum independence for people using services; these are regularly reviewed and replaced to accommodate changing needs. Specialist advice is sought by the home to ensure effective use of equipment. People living in the home are encouraged to manage their own healthcare including visual, hearing, oral and continence care. They have the opportunity to choose their own GP and have access to all NHS healthcare facilities in the local community. Regular appointments are seen as important and there are systems to ensure they are not missed. The home arranges for health professionals to visit residents at home when necessary. The home fully respects the rights of people in the area of health care and medication. They recognise and work with the decisions made by the individual regarding any refusal to take medication, or any specific requests about how their healthcare is managed. Staff members are very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. Staff are trained and competent in health care matters particularly in the care of individuals who remain immobile for long periods of time. The home arranges training on health care topics that relate to the health care needs of the residents. The home has developed efficient medication policy, procedure and practice guidance. Staff all have access to this written information and understand their role and responsibilities. Quality assurance systems confirm that policy is put into practice. Medication records are seen as key to the efficient management of health care matters, the home consistently keeps them up to date. The home has a sustained record of full compliance with the administration, safekeeping and disposal of controlled drugs. Care staff have the required accredited training. The homes policies, procedures and guidance support and inform practice. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively and learns from them. Individuals and others associated with the home say that they are extremely satisfied with the service, feel safe and well supported. All staff working at the service know the importance of taking the views of residents seriously, and of listening to and responding to issues raised. People who use the service are supplied with a complaints procedure that they can understand. This procedure is available in a variety of formats that may include large print, other languages, Braille, audio and pictures. The complaints procedure is clearly displayed throughout the service and is given to all other involved agencies or professionals in the local community. Individuals and their representatives have a clear understanding of how to make a complaint and when they will get a final response. The home also makes sure that individuals are regularly updated on the progress of any investigation into their complaint. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 20 All complaints made and the actions taken in response to them are fully recorded. A review of the number and nature of complaints made is used as part of the quality assurance procedures in use at the service. The home learns from complaints in order to improve its service. They pay particular attention to any themes within complaints that refer to dignity, respect, fairness, autonomy and equality. The home has an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. Policies and procedures regarding safeguarding adults are available to staff and give them clear guidance about what action should be taken. People using the service or their representatives are made aware of what abuse is and the safeguards, which exist for their protection. Access to external agencies or advocacy services is actively promoted. There is a clear system for staff to report concerns about colleagues and managers, which ensures that concerns are investigated in line with local policies and procedures. Staff who ‘blow the whistle’ on bad practice are supported. The home is clear when an incident needs to be referred to the Local Authority as part of the local safeguarding procedures. It is open and transparent when discussing incidents with external bodies. All staff working within the home are fully trained in safeguarding adults and know how to respond in the event of an alert. Knowledge and understanding in this area is constantly checked at team meetings and during supervision sessions. Individual staff are also trained to respond appropriately to physical and verbal aggression and fully understand the use of physical intervention as a last resort. All staff understand what restraint is and alternatives to its use in any form are always looked for. Equipment which may be used to restrain individuals, such as bed rails, keypads, recliner chairs and wheelchair belts are only used when absolutely necessary, with the home promoting independence and choice as much as possible. People using the service are fully involved in decisions about any limitations to their choice. The home fully respects the human rights of people using the service. Individual assessments are always completed which involve the individual where possible, their representatives and any other professionals such as the care manager or GP. There has been no complaints or safeguarding referrals since the last inspection for the service. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 21 Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the people who use the service who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people using the service. The service finds creative solutions to issues with the environment in ways that are not necessarily dependent upon cost. The service goes that ‘extra mile’ to Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 23 provide an environment that fully meets the needs of all residents and plans for the diverse needs of people that might use the service in the future. The environment reflects the differing needs of residents under the six strands of diversity: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. Residents are encouraged to see the home as their own. It is a very well maintained, attractive home and has very good access to community facilities and services. It has a wider range of up to date specialist equipment and adaptations to meet the individual needs of people who use the service. The environment is fully able to meet the changing needs of people, along with their cultural and specialist care needs. It is fully accessible throughout to people with physical disabilities, adaptations and specialist equipment are designed to fit within the homely environment. The management has a proactive infection control policy and they work closely with their own staff and external specialists, such as NHS infection control staff, to ensure that infections are minimised. The home has single rooms available for all people who wish to have one. The fixtures and fittings are of high quality, well maintained and adapted to meet the wishes of the present occupant. Individuals personalise their rooms and can use their own furniture if they wish. The environment promotes the privacy, dignity and autonomy of residents. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The kitchen and laundry are designed to enable and promote the involvement of people in domestic tasks and as part of developing or maintaining independence. Where there are concerns about the health and safety of anyone using the kitchen and laundry arrangements are fully risk assessed with the involvement of the person. Access is only limited when the completed assessment indicates such a need. Staff wear personal protective clothing and for food handling/safety. The paving slabs in the garden seating areas were observed to be pleasant and safe abd were enjoye dby people on the day of the visit. People spoken with told us the home is always very well lit, clean and tidy and smells fresh. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 24 Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: The service has a highly developed recruitment procedure that has the needs of people who use the service at its core. The recruitment of good quality carers is seen as integral to the delivery of an excellent service. The service is highly selective, with the recruitment of the right person for the job being more important to the filling of a vacancy. People who use the service are involved in the recruitment of staff and receive training and support to do this. The service has plentiful staff available at all times to support the needs, activities and aspirations of residents in an individualised and person centred way. The service is innovative and shows a high level of awareness of staffing levels needed. The service is proactive rather than reactive in its staffing, recruitment and training, with planning for the potential needs of people who may use the Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 26 service in the future. The result of this is a diverse staff team that has a balance of all the skills, knowledge and experience to meet people’s needs. There is evidence that they demonstrate a thorough understanding of the particular needs of individuals, and can deliver highly effective person centred care. The acting manager told us in the AQAA that only three out of eleven staff, have NVQ 2 or above. The staff team support each other and share skills and knowledge with colleagues. The roles and responsibilities of staff are clearly defined and understood, based on accurate job descriptions and specifications. The employer demonstrates that they are proactive and have a very good understanding of equality and diversity throughout the recruitment, induction and training process. There is recruitment of individual staff to meet the specific identified needs of people using the service. This could be called ‘matching’. There is wide diversity in the staff team and its composition reflects the diversity of people in line with the six strands of diversity. People who use the service consistently report that their needs are met by the staff team that support them. The service ensures that all staff within its organisation receives relevant training that is targeted and focused on improving outcomes for residents. The service uses external providers to deliver this training if they have not got the appropriate skills within the organisation. This training can be small scale and individualised if necessary in order to promote the delivery of person centred services. Staff consistently report high levels of satisfaction about the employer. People also report that they know the staff team well, know their names and are able to communicate with them freely and easily using their preferred method. The service sees induction and any probation as vital to the success of staff recruitment and retention. The content of the induction and probationary periods are seen to be very robust, detailed and service specific. Induction training exceeds Skills for Care requirements and could include person centred planning and thinking. The service only confirms permanent employment when satisfied that competence and progress has been shown to be satisfactory against their high standards. There are robust and imaginative contingency plans for cover for vacancies and sickness. There are well thought out systems for the induction and support of agency or temporary staff to ensure continuity of care. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 27 The interview and selection process is based upon identified criteria that are closely related to the job being advertised and supports the procedure. People who use the service are positively involved in the choice of staff and their training, and their opinions are valued and acted upon. All elements of recruitment are accurately recorded and the required documentation is always received prior to the employee starting work. Staffing levels reflect the needs of the people using the service, and rotas are flexible to fit around the lifestyles of individuals. Key workers may have specific allocated time to spend with individuals. Staff have the skills to communicate effectively with all residents. Staff meetings are used for consultation and training and staff. Individual supervision sessions take place regularly and staff say that they find them useful for their development and can demonstrate practical outcomes. Notes are taken which include action plans. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a competent manager. EVIDENCE: The acting manager has been in post for twenty one months but has not yet applied to be registered by the Commission for Social Care Inspection. She told us at the previous inspection that an application would be submitted for consideration but this wa sstill outstanding she also reported that she has not yet fully completed the Registered Manager’s Qualification. The acting manager stated in the AQAA: Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 29 ‘As a service provider, Mencap has a continuous improvement framework that sets out how we promote and assure the quality of service to the people we support. This begins with the way we work with people everyday using person centred planning. We also have clearly defined processes for gaining feedback from service users and stakeholders, meeting our compliances, monthly monitoring visits and annual reviews of the service. We recognise that the manager of the service needs to ensure that the activities within the service achieve a balance of creating an environment where the people we support feel both safe and secure and empowered to achieve the things that matter to them.’ The AQAA contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The manager’s practice, skills, and knowledge, is based on continuous development, gained through training and enthusiasm for the role. The service has sound policies and procedures in place [apart from one on continence management], which the manager effectively reviews and updates, in line with current thinking and practice. The home works to a clear health and safety policy. All staff are fully aware of the policy and are trained to put theory into practice. Regular random checks take place to ensure they are working to it. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The home has a consistent record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. Records were well organised and the electrical safety certificate now up to date. Some windows restrictors have now been adjusted to the safe opening limit. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 4 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 4 X 2 4 X Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 31 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA37 Regulation 8 Requirement The acting manager must submit an application for Registration with CSCI [Commission for Social Care] promptly to ensure that she is compliant with Regulation 8 The acting manager must undertake the Registered Managers Award promptly to ensure that she is compliant with Regulation 8 Timescale for action 15/06/08 2. YA37 8 15/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA41 Good Practice Recommendations There is no policy in place for continence promotion, which needs to be addressed. Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Limetree Avenue Care Home DS0000008709.V364273.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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