Inspection on 26/11/08 for Smock Acre

This inspection was carried out on 26th November 2008.

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

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

Other inspections for this house

Smock Acre 18/12/06

Smock Acre 06/12/05

Smock Acre 22/07/05

Smock Acre 08/02/05

Smock Acre 15/11/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Smock Acre Hollow Lane Hoath Canterbury Kent CT3 4LF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Crosby     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Smock Acre Hollow Lane Hoath Canterbury Kent CT3 4LF 01227860136 Telephone number: Fax number: Email address: Provider web address: smockacre@theavenuestrust.co.uk Name of registered provider(s): Type of registration: Number of places registered: The Avenues Trust Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Smock Acre is a care home, first registered in 1999 to provide accommodation and personal care to 3 adults with a learning disability, who have additional physical needs. The registered provider is the Avenues Trust Limited, which has been operating since 1993 and is now a major provider of residential support services in South East England. Maintenance of the building is by Kelsey Housing Association. The home is a large, spacious bungalow along a farm road outside the rural village of Hoath, surrounded by fields. It is approximately 8 miles from the city of Canterbury and 6 miles from the seaside town of Herne Bay. There is a half-acre garden at the rear, and a large flat garden at the front. The home is not on any direct bus route, and the farm road does not have footpaths or street lighting. Residents rely on the homes own Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 3 Brief description of the care home adapted minibus to access the community. There is a drive on either side of the site with ample parking spaces in each case. The home itself is fully wheelchair accessible. The fees for support from the home are set during the assessment period and are very individual to the needs of the person supported, depending on the level of support required and the staffing numbers provided. The average fee levels start at various levels and currently go up to £2,250.00 per week. Care Homes for Adults (18-65 years) Page 5 of 28 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: The quality rating for this service is 3 star. This means that people who use this service experience excellent, quality outcomes. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last inspection of 18 December 2006, including an Annual Service Review dated 21 December 2007 and a visit to the home. The key inspection visit was unannounced and carried out on Wednesday 26 November 2008 between 10.30 and 15.30 hours. During the inspection the inspector spoke with the registered manager, staff on duty, and people supported by the home. Various Care Homes for Adults (18-65 years) Page 6 of 28 records were seen and an accompanied tour of some areas of the home was made. The manager became the registered manager in December 2007, and had previously worked at the home as deputy manager since September 2007. It is indicated that she has worked proactively to bring about positive changes for the people supported by the home. Unfortunately, the Annual Quality Assurance Assessment (AQAA), documentation was not sent out to the home prior to the visit. The previous AQAA documentation completed by the then registered manager at that time has not been used in this report. Discussion with the registered manager identified that via the Avenues Our Say team that service users wish to be addressed as People we support and this report has therefore addressed service users as people supported by the home. The findings of this inspection were discussed with the registered manager at the end of the visit, and overall indicate that this home is providing sustained good quality outcomes provision for the residents and in line with CSCI ratings agenda this service has achieved an excellent 3* rating. What the care home does well: What has improved since the last inspection? 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Adults (18-65 years) Page 8 of 28 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 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 28 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. Prospective service users are provided with the information they need about the service. A full assessment of their needs is undertaken to ensure that prospective service users needs could be met by the home. Evidence: The statement of purpose and service user guide was seen for the home. Small amendments are needed to the Statement of Purpose for example the address of the Commission and updated information about quality assurance reports. The service user guide contains text together with photographs and pictorial symbols and the different formats used may enable people supported by the home to understand the guide in relation to the services provided. There has been one new admission to the home this year and it was seen that in line with company policy all initial assessments are undertaken with multi-agency Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: participation, including care managers, service users and families/advocates if so chosen by the prospective service user. A range of comprehensive information was seen that was used as a basis for the individual care plan. Assessments include risk assessments, full assessment of needs, what the prospective service user wants to achieve and a detailed support plan. Any wishes expressed by a prospective service user are noted and subsequently worked towards, both short and long term goals are developed and supported. Currently people supported by the home would also be fully involved in any placement into the home, only after ensuring everyone is comfortable and happy, does a placement become permanent. The newest person supported was able to visit the home on a number of occasions and experience an overnight stay before having to decide if they wished to live permanently at the home. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Persons supported by the home can be confident that their needs and goals are assessed and monitored. They can also be sure that they are involved in decisions and they will be supported to take risks if necessary. Evidence: One plan of care was seen for the recently admitted person. Comprehensive information was seen and included components as required by regulation. The person centred plan is being developed over a period of time as staff work closely with the person supported and are able to indicate progress and changes that are being made for example person supported being able to put teabag into cup when wanting a cup of tea, and also indicating choice of squash drink required by pointing when examples are given. There was evidence seen that not all records are appropriately signed and dated, and that written reviews were not seen for the recently admitted person supported by the Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: home. The registered manager confirmed that she would take appropriate action to ensure that all documents are appropriately signed and dated by staff, and the reviews are written up. Choices are given at all times with each day being spent as each individual wishes. Planned outings/activities are only undertaken if the person supported by the home wishes, if refused, alternatives are offered until a suitable activity is decided upon. The reason for not participating in certain activities is recorded to support the change and review of activities on care plans. Other information on care plans includes a personal history, information on preferred lifestyle and risk assessments. Relevant company policies and procedures are presented in symbol and audio format and people supported by the home are consulted on the running of the home through regular meetings with their keyworker. Persons are supported to take reasonable risks to allow them to undertake the activities they wish to. All risk assessments are kept under review. The personal information in relation to persons supported by the home is kept secure. Staff are briefed on their responsibilities to maintain confidentiality as part of their induction into the home. Care Homes for Adults (18-65 years) Page 14 of 28 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. Persons supported by the home enjoy their chosen activities, many of which are undertaken in the community, providing both choice and control. Friends and family relationships are encouraged and supported by the home. Evidence: Persons supported by the home were included in this inspection process and individual support was appropriately given with due consideration for dignity and independence. Discussion took place with the registered manager about opportunity sessions that have enabled the people supported to indicate their choices for example in choosing colours, and food items. All activities are decided through consultation with the individual and clearly set out in their person centred plan and supported by appropriate staffing levels. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: Activities currently undertaken include hydrotherapy, bowling, visits to the cinema, shopping, attending the Avenues Day Service for sessions for example gardening, art, social exercise and relaxation/ sensory. All relationships that are important to people supported by the home is encouraged and constant contact supported. Events in the home are undertaken with involvement and support from friends and family this being confirmed by staff spoken with. One of the people supported has been assisted to visit their family who live approximately seventy miles away, and one person supported is being assisted to meet and have a meal with family together with shopping for Christmas. A variety of food choices are available and individual records are maintained. People feel their rights as citizens are recognised and promoted, including fairness, equality, dignity, respect, and autonomy over their chosen way of life. This service is consistently providing good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The healthcare needs of people supported are well met. Staff consider the dignity of persons supported and treat individuals with respect. Medication is administered and stored appropriately. Evidence: Health professionals provide support that enables staff to give full care to each person supported. Healthcare visits are recorded and were evidenced in a sampling of records undertaken at this time. All persons supported have access to appropriate healthcare professionals and this is evidenced in care plans and notes of all healthcare visits. The registered manager has worked proactively to liaise with other professionals to enable the persons supported at the home to maintain the best possible health for example the medications for one person supported has been greatly reduced with good effect, and one person supported who was regularly admitted to hospital and frequently prescribed antibiotics, due to changes that have been made is now enjoying much better health. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: Medication is administered via a monitored dosage system (MDS) and all relevant policies and procedures are in place. Medication training and individual competencies are assessed within the home and regularly reviewed. Competencies are assessed through observations, discussions and questions regarding medication and its affects. The records seen indicated that they were appropriately signed and up to date, and the medications stored were appropriate to meet the needs of the current group of people supported. Care Homes for Adults (18-65 years) Page 18 of 28 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. Persons supported are listened to and routines and practices in the home support and protect the people. Evidence: There is a complaints procedure in place that is also available to persons supported in CD and video format. The registered manager has previously explained that there is ongoing good relationship with family and friends that encourages open discussions at all times. Staff receive training in abuse awareness as part of their induction. Where persons require support regarding agitated behaviour, clear guidance is contained in the individual plans. Incidents are recorded, monitored and appropriately reported to the Commission for Social Care Inspection. The home has a comprehensive system for the recording of persons supported finances that includes a daily check by staff on personal allowances and the retention of all receipts to cover any expenditure. Staff double check all balances and two signatures are recorded at change over of shifts. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. Persons supported rooms are personalised and respected as an individuals own space. Evidence: The accommodation at Smock Acre is all on ground level to enable wheelchair access to the front and rear of the building. Rooms are spacious, light, airy and personalised with personal pictures of activities and holidays that have been enjoyed. There are gardens to the rear, side and to the front of the property and adequate off street parking. Since the registered manager took up post the whole of the interior of the premises has been re-decorated and new furniture has been purchased. This has proved beneficial to the people supported by the home, allowing choice of colours and creating a much lighter environment. Rooms are very individual, pictures and ornaments decorate bedrooms. Sensory light equipment was seen in one bedroom that had recently been purchased for one of the Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: people, and the registered manager discussed plans to provide a large screen television for one of the people supported that has a visual impairment. Work has been undertaken in the gardens, a poly tunnel is in place, and pathways have been cleared all around the house providing safe access for the persons supported. The registered manager said that there is a sensory area around the back of the patio area, and plans for an edible sensory garden are being discussed. An overhead hoist attachment has been fitted in the bathroom and a new portable hoist has also been purchased. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of skilled staff in the home to support the people who use the service. The homes recruitment policy and practices protect the people supported. Evidence: The home operates with a full time manager and a minimum of two care staff day, however there are mainly three carers on shift during the day. At night there is one waking carer and one sleep in carer. At the time of the inspection visit, the registered manager was on duty with three carers, one of whom left to attend a training session. A keyworker system is in place, and most of the time the people are supported on a one to one basis. There are no dedicated ancillary staff, support staff do all the cooking and cleaning and are to be commended on the high standards maintained in each case. All new staff undertake a full induction programme within the first six weeks of employment and statutory training is completed within the first six months. Staff training is identified by the registered manager during the appraisal process. This process forms the basis of training provided throughout the organisation. The training Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: schedule was seen and staff spoken with confirmed that the company provides ongoing training. The registered manager said two new members of staff already have NVQ 2 and currently six out of the nine members of staff are NVQ trained, Staff attend Diversity training and policies and procedures are in place to address equality and diversity. Equality of opportunity, fairness and consistency of treatment are at the centre of everything the company does not only for employees but more importantly for the people supported. The company has a robust recruitment procedure that includes gaining full CRB checks prior to any staff commencing work. New employees are required to visit the home prior to their start date to meet people supported by the home and staff. Staff have regular supervision and staff spoken to at this time confirmed that they feel supported by the registered manager and the staff team. A board in the hallway clearly identifies staff on shift and large photographs of each member of staff support this information enabling the people supported to be aware of who will be in the home and providing support. People are well supported by a staff team that recognises and responds appropriately to their diverse needs and human rights. This service is consistently providing good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People supported benefit from good leadership from the manager who is well supported by the staff team and the people supported can be confident that their home is well run. The staff and routines in the home protect the people supported and promote their safety and well being at all times. Evidence: The registered manager holds the RMA qualification and is currently undertaking a Diploma in Management. It was evident through discussion with staff that they are well supported and involved in the running of the home. The registered manager has been proactive in making positive changes in the home that has directly led to a better quality of life for the people supported by the home. Quality assurance monitoring is regularly undertaken to assess the level of care being given and also the quality of the environment in the home. Regular Regulation 26 Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: visits are made and regular staff meetings are held. Opportunity sessions are carried out to find out preferences and wishes, likes and dislikes of the people supported. The opinions and wishes of people supported are considered in current and future plans. The safety, health and well being of the people supported are considered at all times and the home works in a relaxed and inclusive way. Staff are trained in core skills that support the peoples needs and well being. Life skills and goals are supported by staff and the routines in the home are dictated by the people supported needs and wishes. People enjoy as good a quality of life as possible because the home is managed in a way that takes into account and promotes their human rights and equality and diversity needs. This service is consistently providing good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!