Inspection on 20/06/07 for The Avenue

This inspection was carried out on 20th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

The Avenue 25/02/10

The Avenue 26/10/09

The Avenue 28/04/09

The Avenue 25/01/07

The Avenue 20/03/06

The Avenue 18/10/05

The Avenue 22/02/05

The Avenue 17/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Avenue 6 The Avenue Keynsham Bath & N E Somerset BS31 2BU Lead Inspector David Smith Key Unannounced Inspection 20th June 2007 11:00 The Avenue DS0000008167.V338946.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 The Avenue DS0000008167.V338946.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. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Avenue Address 6 The Avenue Keynsham Bath & N E Somerset BS31 2BU 0117 9864700 0117 9862524 helen.hill@sovision.co.uk 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) Keynsham & District Mencap Family Home Mrs Helen Barbara Hill Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 8 persons aged 19 - 64 requiring personal care only May accommodate one named person aged 65 years and over. Will revert when named person leaves. 25th January 2007 Date of last inspection Brief Description of the Service: The Avenue is a large four storey, semi-detached property situated in Keynsham. It provide accommodation for eight people between the ages of 18 and 64 years of age who have a learning disability. One person is over the age of 64 and there is a specific condition of registration in place for this person. The house has a basement flat that provides accommodation by way of a selfcontained living area. This comprises of two bedrooms for two residents, a bathroom and a small kitchen. The first and second floor of the property provide accommodation for six residents. The home has secured planning permission to extend the ground floor to provide an accessible bathroom. The home is within easy access of local amenities that include a leisure centre, shops and park. There are accessible transport routes to Bath and Bristol by both bus and train. There is also a mini bus for residents to use. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home by myself and one colleague as part of a Key Inspection of this service. We gathered information during our visit through discussions with Residents, the Registered Manager and staff members. Interaction and communication between staff and individuals who live in the home was also observed during our visit. Care plans and associated records were examined together with accident and incident reports, medication administration, staffing records, Risk Assessments and health and safety records. We were provided with a tour of the home and invited by a number of residents to view their own rooms. The home was provided with their Annual Quality Assurance Assessment (known as AQAA, pronounced as ‘aqua’) and a range of survey forms for residents, relatives, carers, advocates and healthcare professionals, prior to our visit. The AQAA was completed in detail and returned together with nineteen surveys. Other sources of evidence have been used as part of the Key Inspection process. These include the home’s own Quality Assurance Assessment completed in March 2007, notifications of significant events which have occurred within the home and reports of the provider’s own monthly auditing of the service. The people who live at The Avenue are known as “residents” rather than ‘service users’. This has therefore been acknowledged and replaced the term “service user” in this report. What the service does well: Residents spoken with and those who responded by survey said they are always treated well by staff and supported to do the things they wished to do. Relatives, carers and advocates who responded by survey said the home meets the needs of each resident and supports each person to live the life they choose. The healthcare professionals who responded by survey said the home always seeks and acts upon their advice to ensure each resident’s healthcare needs are met. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 6 The home is very well run. The ethos of the service is clear, well communicated and remains focused on positive outcomes for each person who lives in the home. The care planning system is person centred and comprehensive. This ensures each resident receives appropriate levels of support. The administrative systems are very efficient and enable quick and easy access to any documentation required. This ensures a safe and accountable system of support for residents and staff. The staff team are friendly, professional, and very confident and were observed to engage well with residents and others who visit the home. The home actively seeks support from other professionals to help improve the quality of the service it provides to each person. What has improved since the last inspection? 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. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 7 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 The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 8 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 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information to enable them to choose if they wish to live in the home. Each resident is provided with a written statement of terms and conditions with the home. EVIDENCE: The home has a comprehensive Statement of Purpose, which is regularly updated. This provides a description of the home, its aims and objectives, quality assurance, facilities and services the home offers and describes the rights and responsibilities each resident has whilst living at The Avenue. Residents spoken with and those who responded by survey said they were asked if they wanted to move to this home and did have enough information to help them decide if this was the right place for them to live. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 9 Each resident has their own guide to the service, which uses plain English and contains pictures and picture symbols to ensure each person understands what is contained in their guide. In addition to this, each person also has a Licence Agreement between themselves, the home and Bristol Churches Places for People who own the property, which state the terms and conditions of each resident’s stay. The Manager told me that these documents would be updated once the extension currently under construction has been completed, so that new photographs and floor plan can be included. One resident we spoke with told us that they would like their new guide to the service to be produced on ‘DVD’ as this could be made to look like a film. They were sure staff at the home would help them do this. There have been no new admissions to the home since 2002. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 10 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, 8, 9 and 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home ensures that the service provided to each individual takes into account their personal preferences, supported by both written information in care plans and risk assessments which are subject to ongoing review and a long standing and experienced staff team. Residents are consulted on, and participate in, all aspects of life in the home. EVIDENCE: Two care plans were examined in detail and these provided comprehensive information on the areas of support each person required. Each care plan had been written in an individual way and covered key areas of support people required. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 11 These include information relating to health, personal and social care, independence training (including personal and living skills programmes) and money management. The care plans also described more complex needs, such as how to respond and support an individual if they become distressed. Regular formal review meetings are held, which include residents, their families, staff members, Social Workers and Keyworkers. Each resident is supported to prepare for, plan and attend their review meeting. These meetings are clearly recorded and the outcomes used to update individual care plans. The home operates a keyworking system whereby each resident has a named member of staff who plays a key role in co-ordinating the services they receive. Between each formal review Keyworkers ensure that residents’ changing needs are monitored through regular review of their care and independence training plans. This is good practice. The home has recently introduced person centred plans for those individuals who wish to have one. Three plans have been concluded and whilst others are planned, each individual can decide if they wish to have one rather than the home simply developing them for all residents. Interactions between staff and people who live in the home were observed at various times during our visit. These demonstrated the staff had a very good knowledge of the support needs of each resident and how to communicate effectively. Discussion between the manager, staff members and us also confirmed this. Each resident we spoke with said they decided what they would like to do and that staff members always listened to them and acted on what they said. There are regular residents house meetings, the last of which was held on 28/05/07. The records of these meetings show that attendance is good, with a wide variety of topics discussed. The views of Residents are taken seriously and acted upon wherever possible. Independent advocates provided by “Your Say” support each house meeting and produce an easy read summary of the meeting, which uses plain English and contains picture symbols. Care and support is provided within a risk assessment framework. Healthy risk taking continues to be encouraged and supported, as evidenced within the wide range of opportunities and activities residents are able to enjoy. Each of the person centred risk assessments we examined were detailed and have been regularly reviewed. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 12 Each resident has a document describing the right of access to their personal records, which forms part of their care plan. This ensures confidentiality is promoted and explained to each person who lives in the home. All records relating to residents are stored securely in the main office. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each resident has opportunities and appropriate support to develop, access work, leisure and educational facilities both locally and in the wider community including holidays, day trips and visits to family and friends. Each person’s rights and responsibilities are recognised in their daily lives. A healthy and balanced diet for each individual is promoted. EVIDENCE: The home has developed a person centred approach in supporting each resident to develop. The records maintained within the home enable each persons progress towards their goals/dreams to be assessed and the support provided adapted accordingly. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 14 Each resident has their own timetable of activities. These show regular access to local community facilities such as Day Services, shops, cinema, pubs and other activities such as swimming or horse riding. Residents spoken with and those who responded by survey said they made decisions about how to spend their day and felt they were supported to do the things they chose. It was evident that many residents had made significant progress since moving into the home. Some were attending more varied services or longer sessions. Others access the community independently, attend college courses and make use of public transport. The home has made significant progress in supporting people who live in the home to access work/work placements in the local community. One resident we spoke with said they enjoyed their jobs at Marks and Spencers and the local hospital. It was noted that home had worked hard to gain full employment rights and equal pay for this individual, which is commended. They also have recently joined a band, in which they play the guitar. They were supported by the manager to perform in public with their band on the day of our visit. Staff spoken with explained that they work hard to ensure each person is provided with opportunities to do things which they enjoy. Each person is seen as an individual and is respected as such. Individual’s rights and responsibilities are made clear and confirmed in writing in their guide to the service and the resident’s charter. Each person has a key to their bedroom and individuals we spoke with said they could lock their bedroom door if they chose to do so. They also told us staff always knocked on their door and waited for a response before entering their room. Individuals are supported with maintaining friendships and contact with families. The staff have known the residents relatives for a long time and promote ongoing communication with them. The relatives, carers and advocates who responded by survey said the home ‘always’ provided the care and support they expected for each resident, helped them keep in touch and kept them informed of important issues. One relative said “the standards at the home are exceptionally good”, another said they “are absolutely delighted with the care” and another relative said “the home needs no improvement, it is wonderful”. Each individual is supported to organise and attend a holiday. Many of the residents we spoke with told us of their holiday to Spain planned for this September and also to a ‘turkey and tinsel’ weekend prior to Christmas, which appears to have become a regular and extremely popular event. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 15 Each resident has access to a kitchen where they can prepare their own drinks, snacks and meals. Weekly menus are planed in consultation with them and these show a wide range of food, which provide both a healthy and balanced diet. Each person’s likes, dislikes and allergies in relation to food are known and clearly recorded. Residents support the Good for You Catering Crew”, a group of people who have learning disabilities, who provide the home with ingredients to make both a starter and main course together with pictorial and easy read recipe cards for residents to follow. The Residents are encouraged to send back a comment sheet and suggestions for the next weeks meal. On the day of our visit residents were involved in preparing the evening meal using this method. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 16 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. Residents are supported in their preferred manner and their personal and healthcare support needs are very well met. Residents retain and administer their own medication where possible and the policy relating to administration of medication ensures their welfare and safety. EVIDENCE: The care documentation in place for residents provided clear guidance for staff on how they should support those living at the home with their personal care. The care plans examined showed that individuals were registered with a local GP, dentist and optician. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 17 Other specialist services are accessed when an identified need arises. These are provided by the local Community Learning Disability Team (known as ‘CLDT’). Care records show the home is regularly supported by the Consultant Psychiatrist, Physiotherapists, Speech and Language Therapists, Occupational Therapists and other relevant health care professionals. The home also supports residents to use other services such as reflexology, massage, aromatherapy, Indian head massage and acupuncture. Contact with each professional or use of therapies is recorded and forms part of each persons care plan. Residents are now being actively encouraged to create their own ‘Health Action Plan’. Each individual’s plan will contain information which each person considers to be important about them and these will be produced using a format which each person can understand. Professionals from the CLDT are supporting residents with this process. The home has a very experienced staff team who have a good knowledge of residents’ healthcare needs. Any changes, which may cause staff concern, are noted and acted upon. It remains evident that the management and staff spoken with are sensitive to the personal/healthcare and emotional needs of those living at the home. We did note the home continue to advocate for and support residents in relation to their changing healthcare needs. This has led to one resident having a hip replacement operation and another having a ‘bone anchorage’ hearing aid fitted. Once the current building works are completed the home will also have an accessible ‘wet room’ on the ground floor in addition to the recently fitted stair lift in anticipation of the changing healthcare and mobility needs of the people who live at the Avenue. The healthcare professionals who responded by survey said the home does meet each person’s health care needs, seeks their advice and acts upon this to manage and improve individual’s health care. One professional said “the home offers a very high standard of care and individual’s needs are met”. The home uses the Boots Monitored Dosage System of medicine administration and this system is well managed. One individual currently self-medicates and there is a Risk Assessment in place to support this practice, which is regularly reviewed. The medication administration file contains the home’s medication policy, details of each person’s GP, a recent photograph, profiles of prescribed medication, guidance on expiry dates of medication, examples of staff signatures and the initials they use on medication records and information relating to returning medication. Each resident’s medication record was correctly completed, signed by both residents and staff with no gaps evident in the records. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 18 Staff are provided with formal training in relation to medicine administration. The records we examined showed that all staff have completed Boots Care of Medicines Training and staff spoken with said they had also now completed ‘Protocol Training’, which is accredited by the City of Bath College. This is in the style of an NVQ unit and contains four elements; introduction to medicines, care workers role, administration and medicines of differing client groups. The Avenue DS0000008167.V338946.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. Residents are supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clear policies and procedures are in place in order to protect individuals from the likelihood of abuse, neglect and self-harm. EVIDENCE: Each resident has their own complaints procedure entitled “I Want To Complain”. This is written in plain English and contains pictures and picture symbols to help each person understand the content. Families and other people involved with the home are also provided with a copy of the home’s complaints procedure. A Local Authority complaints leaflet supplements these documents and the home also has a confidential reporting policy if staff have any concerns regarding the service they work in. Each resident we spoke with and those who responded by survey said they knew who to speak to if they were unhappy or wished to make a complaint. The residents we spoke with said they ‘really liked’ living at the Avenue and were ‘happy’ here. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 20 We examined the home’s concerns and complaints log. This shows there has never been a formal complaint made direct to the home. The CSCI has not received a complaint or any other concerns regarding the Avenue. There are policies and procedures in place relating to the issue of protection of vulnerable adults from abuse. Training records indicate that all staff have attended training in the protection of vulnerable adults. Some staff members recently attended the advanced ‘investigators’ training through the local council. The relatives, carers and advocates who responded by survey said they knew who to speak to if they were not happy with the service provided by the home and were aware of the home’s complaints procedure. They also said the home ‘always’ responded appropriately to any concerns they may have. The healthcare professionals who responded by survey said the home does respond to any concerns about individual’s health or aspects of their care. One professional said “the team always responds appropriately” to any concerns they may have. There is very little challenging behaviour displayed by people who live in the home. It was evident that some individuals have seen a significant reduction in incidents such as these since moving into the home. The Manager said that the home worked extremely hard to enable each person to communicate appropriately and effectively, set appropriate boundaries and provide them with a stable home life. She felt this had a significant effect on individuals who had previously displayed varying levels of behaviour, which were seen as challenging. Each staff member, committee member or volunteer is subject to an Enhanced Criminal Record Bureau Disclosure, prior to working in the home. The home maintains clear records of all accidents and incidents. It also notifies the CSCI of any significant event which occurs within the home. We noted that the home continues to receive letters and comments from families, friends and other people involved with the home which are extremely complimentary regarding the high quality of the service provided and about the home and staff team more generally. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 21 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, 25, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Avenue provides a homely, comfortable and safe environment for residents to live in. EVIDENCE: The Avenue is a large, four storey, semi -detached stone-built, property situated in the community of Keynsham. There are car parking spaces to the front and a large garden and patio area to the rear of the property. The home blends in well with the local community and is situated in a very quiet location which provides easy access to local shops and public transport routes to Bath, Bristol and other local areas. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 22 There are eight single bedrooms, a communal lounge, dining room, utility room, kitchen, toilets, showering and bathing facilities. The basement floor of the home is used as a self contained flat for two individuals who have their own bedrooms, separate kitchen and bathroom. We did view all of the communal areas of the home during our visit, along with five of the resident’s rooms. All areas of the home were clean and tidy and furnishings and fittings are of a good quality. The house is tastefully decorated and there are many photographs of residents displayed, which help to personalise the home. Each part of the home was very light and ‘airy’. Each person’s bedroom has been decorated and furnished to make it personal to them. There were lots or personal effects, pictures and photographs which added to this. Two people who live in the home told us their rooms would be improved when the building work is completed. One resident will have a new double glazed window fitted and another individual explained they would like new furniture in their room and change the colour scheme. The staff would help them with this project. Each resident is expected to help keep their home clean and tidy, with each person’s responsibilities clearly reflected in the list of duties displayed on the notice board. This is supported by the ‘Our Daily Chores’ file, which contains photographs of residents hoovering, polishing and cleaning all areas of the home. The residents we spoke with told us they all helped keep their home clean and tidy and were happy to do this. The home is in the process of having an extension built to one side of the property. Once this project is completed this will provide the home with additional space and facilities such as a ‘wet room’ containing a fully accessible toilet and shower, a new staff sleeping-in room, a ramp up to the level of the front door, a new office and storage space for old records. The existing utility room will also be relocated and this will prevent staff and residents having to walk through the basement kitchen to access this room, as they presently have to do. The manager told us that the building work is ahead of schedule and should be completed within the next few months. This will be a positive development for each person who lives or works in the home. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 23 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): 31, 32, 33, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person that lives in the home is supported by a cohesive and effective staff team that is committed to providing a good service. The clarity of staff roles and responsibilities along with staff training and supervision helps to provide a consistent approach to the support of staff and residents. EVIDENCE: There remains a well-established staff team with varying abilities who are skilled and experienced to meet the needs of those living in the home. Staff spoken with were able to demonstrate a clear understanding of their role and responsibilities within the team and their own personal role and accountability. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 24 There is a very low turnover of staff and sickness rates also remain very low. The home has never used agency or relief staff to cover vacant shifts, as the existing team remains flexible in their working hours, as well as providing cover at short notice. This ensures each resident is supported by a familiar and consistent staff team. Staff members we spoke with said that the staff team continues to be very open, honest and supportive. Each commented on how nice it is to work in the home. They felt well supported by the manager and were able to discuss issues in an open and honest way. Staff were observed interacting extremely well with each resident and those spoken with demonstrated a good understanding of the support needs of each person in the home. The residents we spoke with said they like the staff and felt they are well supported by them to live the life they wanted. Residents who responded by survey said the staff always listened to them and acted on what they said. The relatives, carers and advocates who responded by survey said the staff team have the right skills and experience to support the people in the home live the life they choose. One relative said the staff team are “all very caring people who have the interests and care of the residents as their prime aim”. The healthcare professionals who responded by survey also said that the staff team have the rights skills and experience to support each individual. The staff team meets regularly. All meetings are recorded and appropriate subjects are discussed in order to guide and direct staff practice. It was evident through observation and discussion with staff, that the team operates effectively and are supportive of each other communicating openly. There is a strong commitment by the home to provide staff with a variety of training opportunities. All staff have completed a National Vocational Qualification (known as an ‘NVQ’) and mandatory training such as First Aid, Manual Handling and Food Hygiene. Staff have also attended more specialist training such as Mental Health, Intensive Interaction, Makaton signing, Diabetes, Autism/Aspergers Syndrome and assessing risks. Planned training includes the Mental Capacity Act, Infection Control and support for staff who have completed NVQ Level 2 to attain a Level 3 Award. Staff spoken with said the manager provides them with regular structured supervision sessions to support them in their work, which they find helpful and supportive. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 25 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, 38, 39, 41, 42 and 43. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is very well run and has effective procedures in place to provide residents with the support they require to lead fulfilling lives. Residents benefit from the ethos, leadership and management approach of the home. Residents’ views are central to the monitoring and review of the service provided by the home. Residents’ rights and best interests are promoted by the quality of the home’s record keeping. The health, safety and welfare of residents is promoted and protected. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Manager, Mrs.Hill, has managed the home since 1994. She has attained both Foundation and Advanced Management in Community Care through City and Guilds, NVQ Level 4, the Registered Managers Award and is a qualified NVQ Assessor. She also undertakes periodic training to maintain her knowledge and update her skills and level of competence. The management approach remains open and positive, with a clear sense of direction and leadership. The ethos of the service is person centred with the views of residents central to this process. Staff spoken with said their views are always listened to, and that they are well supported by the manager. Through discussion with the Registered Manager, staff members and a number of residents it was evident there continues to be an inclusive atmosphere within the home. The residents remain the focus of the service and the Registered Manager is clearly leading and developing the person centred approaches. Although the current building works are adding to manager’s workload, the quality of record keeping in the home remains excellent. All of the records required during our visit were easy to access and all were stored securely in the home’s office. The involvement of residents in both the day-to-day running of the home and in proposed developments or improvements of the service remains high. There are regular house meetings, where a variety of topics are discussed such as the home environment, housework, the garden, how to complain, fire safety and how to stay safe. The home encourages the use of advocacy to support each person’s involvement and to help them make informed decisions. The home is supported by “Your Say” advocacy service, who help the residents with their own meetings and have supported them complete questionnaires in relation to the service they receive. Several residents also attend ‘include to inform’ (known as i to i) which is an action group for adults with learning and physical disabilities. Transport is organised by the service to enable residents to attend this group where they are able to be independent from the home’s staff team and meet a variety of different people who are new to them. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 27 Several people who completed surveys made specific reference to how well the home was run and how highly they regarded the Manager. One person said “it is a very well run home” and another that the home has “a very competent Manager who manages the home very well”. The home conducted their own “Quality Assurance Review’’, which was completed in Mach 2007. The home asked Residents, their relatives and friends together with other agencies or services involved with the home to complete a detailed questionnaire. Each Resident was supported by ‘Your Say’ Advocacy Service to complete and return their questionnaire. The information was then collated and the outcomes of the review sent to all relevant parties. It was noted that the feedback was very positive in relation to the service provided by home and any areas where improvements can be made were identified and acted upon. The registered provider’s representative makes regular visits to the home, and produces a comprehensive report of their findings. Although the home is no longer required to forward a copy to the CSCI, we did view several recent monthly reports whilst we were at the home. There are recording systems in place to support Health and Safety within the home, which are being used consistently. Records examined included fire drills, fire alarm system checks, fire fighting equipment checks, hazardous products which are used in the home, risk assessments, gas safety, portable electrical appliance testing and fridge/freezer temperature recording. All of these records were in order and checks were up to date. The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 28 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 X 3 X 4 X 5 3 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 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 4 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 4 3 LIFESTYLES Standard No Score 11 4 12 3 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 3 4 X 4 3 3 The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Avenue DS0000008167.V338946.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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