Care Home: 18 Franklin Avenue

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What the care home does well We spoke with the parents of one person who lives at 18 Franklin Avenue. They are very pleased with the support their daughter gets and made some very positive comments about the home. They said "It`s a lovely home, we`re very pleased with it and they`re very nice people here. The staff respect people. Claire is a very good manager and we always feel welcomed here". Staff said "It`s really lovely working here - I really enjoy it"; and "We have a laugh the home is really happy - it`s more of a home than a workplace. I wouldn`t change the way it is - it`s not perfect, but it`s close". During our visits we saw that staff and the people who live here have very warm, caring, friendly relationships. People and staff like and respect each other, and appear to enjoy each other`s company and have fun. Staff communicated well with people, including giving people time to respond, and were aware of people`s needs and wants. The staff, including the managers, work as a team to make sure this 18 Franklin Avenue runs well for the people whose home this is. Good information about the home is available, and the home has the building, equipment and staffing to satisfactorily meet the needs of the people who live here. Care/support plans contain a lot of detailed guidance for staff on the ways in which each person wants their needs to be met, including their healthcare needs, and staff administer medication safely. People attend day services outside the home if they want to, and some activities are organised, both in the home and outside it, by staff. Healthy, nutritious meals, based on people`s likes, dislikes and cultural needs, are served and the home has achieved the `Smile Award`. People (or their relatives) know how to complain if they need to, and those we spoke with said they were confident their concerns would be dealt with. Staff have been trained to recognise and report abuse so they know how to keep people safe. The bungalow is clean, comfortable and homely and staff are recruited well. Staff are trained and receive regular supervision so that they can do their job properly. The home has a quality assurance system that includes asking people who live here and their families about their views, carrying out regular monitoring audits, and the provider visiting the home. Generally, records are kept as required, the manager told us in the AQAA that all policies and procedures are in place, and tests of the fire alarm system, tests of the emergency lighting, and fire drills are done regularly. What has improved since the last inspection? 18 Franklin Avenue has continued to offer a good service to the people who live here. In the AQAA the deputy manager showed that there are plans in place to improve the service even further. What the care home could do better: Although this is a good service there are still some things the team could do better. There should be enough staff on duty to make sure people`s needs for activities and social stimulation are met; residents money must always be dealt with correctly; and the requirements of the fire service must be met. Key inspection report Care homes for adults (18-65 years) Name: Address: 18 Franklin Avenue 18 Franklin Avenue Barton-le-clay Bedfordshire MK45 4LN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nicky Hone     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 18 Franklin Avenue 18 Franklin Avenue Barton-le-clay Bedfordshire MK45 4LN 01582883465 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: joyce.joseph@aldwyck.co.uk www.aldwyck.co.uk Aldwyck Housing Association care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home 18 Franklin Avenue is a purpose built bungalow, which was registered in 1996 to provide residential care to six adults with learning disabilities. The home currently provides care for adults with profound learning disabilities. Aldwyck Housing Association owns the property and manages the home. People who use a wheelchair can access all parts of the home easily. There are six single bedrooms, a large kitchen/diner and a lounge with views over an attractive patio and garden. There is an adapted spa bath and a level access shower close to the bedrooms, and a sensory room at the front of the bungalow. The home is situated in a residential area of Barton-le-Clay, with easy access to a range of local facilities, such as shops, places of worship, pubs, library and restaurants. The home has its own vehicle so that people are able to travel comfortably to places further afield. 6 6 Over 65 6 0 Care Homes for Adults (18-65 years) Page 4 of 30 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: two star good 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: For this inspection we (the Care Quality Commission) looked at all the information that we have received, or asked for, since the last key inspection of 18 Franklin Avenue. This included: - The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in December 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live here. The AQAA also gives us some numerical information about the service; - Surveys which we sent to the home to give to people who live here. We received 1 reply, written by a parent on behalf of the person who lives here; Care Homes for Adults (18-65 years) Page 5 of 30 - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; - Any safeguarding issues that have arisen; and - Any information we asked the home to send us following our visit. This inspection of 18 Franklin Avenue also included two visits to the home, on 29th December 2009 and 11th January 2010. No-one who was living or working at the home knew we were going to visit on the first day. We arranged the second day with the acting manager so that we could be sure she was on duty. Most of the people who live here have difficulty using words to communicate, so we spent time observing what was happening and how staff and people who live here were reacting to each other. We spoke with people who live here, some relatives, staff and the acting manager. We looked round the bungalow and we looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. The registered manager of 18 Franklin Avenue, Claire Paton, was on maternity leave at the time of the inspection. The deputy manager, Joyce Joseph, who has worked at the home for some time, is acting manager in Claire Patons absence. Aldwyck Housing Association has announced it will be selling its care homes, including 18 Franklin Avenue. According to the acting manager, relatives and the people who live here have been kept informed about the progress of the sale, although at the time of the inspection there were no prospective buyers. The advocate who visits the home is also involved in making sure people understand as much as they can about the sale, and what this means for their future. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Although this is a good service there are still some things the team could do better. There should be enough staff on duty to make sure peoples needs for activities and Care Homes for Adults (18-65 years) Page 7 of 30 social stimulation are met; residents money must always be dealt with correctly; and the requirements of the fire service must be met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 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 9 of 30 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. Good information is available about the home so that people know what to expect, assessments are carried out so that people know their support is based on their needs, and the home is equipped to meet the needs of the people living here. Evidence: There is a lot of useful information for people who want to know more about 18 Franklin Avenue in the Service User Guide which the home has produced. The guide is full of photographs which were taken by one of the people who lives here when he was doing a photography course at college, and contains a lot of detail about what the home offers, in simple language that people using the service could understand. For most of the people who live here, 18 Franklin Avenue has been their home for a number of years. The person who arrived most recently came in 2008. The acting manager said that staff do detailed pre-admission assessments of peoples needs, and meet them several times before the person moves in, wherever they live. The person who moved in in 2008 lived in Cheshire. Staff travelled to her home to meet her, and she made several trips to 18 Franklin Avenue, before making the decision to make it Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: her new home. Each persons needs are regularly re-assessed, both by the staff in the home, and by each persons social worker in their annual review. The acting manager said that annual reviews had been carried out for 3 people, and the other 3 reviews were now booked. When peoples needs change, the changes are recorded, and any amendments needed are made to the persons care plan. Staff at the home also liaise closely with staff at the day services people attend, so both staff teams have a complete picture of how each person is progressing. Our observations, discussions and looking at the paperwork the home keeps about the people who live here show that staff continue to work hard to make sure each person has a good life. Staff have the skills, experience and competence, and the home has the equipment and facilities, to continue to meet everyones needs. Each person has a licence agreement with Aldwyck Housing Association. We saw that these are the original agreements from some time ago, so some of the information contained about costs, and contact details, is no longer applicable. One set of relatives we spoke with said they were not clear about what their relative should be paying for. They told us that currently she pays for everything: toiletries, bedding, towels, outings, holidays (including some staff costs), petrol for the vehicle and so on. We suggested the parents speak to their daughters social worker about this matter. We think the home should be supplying bedding and towels. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans are based on each persons assessed needs and give good guidance to staff on the way each person prefers their needs to be met. People are supported to make decisions about their lives, and risk assessments enable people to be as independent as possible. Evidence: The records the home keeps about each person are separated into 4 files. In the care plan file, the care plan is in 18 sections. We looked in depth at one care plan and saw that it contains a lot of information about the persons needs, and how the person prefers those needs to be met. For example, in the eating section, staff had written that this person eats with a melamine spoon and likes his meat pureed, and that he cannot eat peas, sweetcorn or rice. Care plans had links to other documents, for example risk assessments, medication guidelines, appointment feedback sheets and so on. Good risk assessments had been carried out and recorded, showing that staff attempt to promote peoples independence as far as they can. Each person has a keyworker and we saw that the keyworker completes a monthly checklist to make Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: sure everything is in order, and the person is being supported in the way they want to be. We looked at the care planning documents for a second person. This person receives all her food through a tube into her stomach (PEG feed). We noted that the instructions for staff about rotating the tube and cleaning the site were not consistent. One document said it should be done every day, another document said every other day, and the guidance said daily. We checked the record that staff sign to show theyve cleaned the site, and it was only signed 12 times in the 30 days in November. We know this person goes to stay with her parents frequently, but nevertheless there were far too many gaps on the days the person was at the home. The acting manager said she knows staff do clean the site but they forget to record it. If they did not clean the site, it would quickly become infected: records of health issues showed that she had not had any infections. The acting manager said the company which supplies the food train the staff, or experienced staff train new staff. We noted that all the care plans had been updated in September or October 2009: staff explained the manager had done this before she went on maternity leave. Each month staff discuss each resident and the care plans are updated if they need to be. We looked at one persons PCP (Person Centred Planning) folder. This contained a lot of personal information, including the persons likes and dislikes, and there were a lot of photographs. Staff explained that the folder had been started at the day centre the person attends, so a number of the photographs were of the person doing activities at the centre. This person agreed that we could look at his photograph album, which showed that he enjoys joining in a number of activities, including going on holiday. This year he went to Blackpool with another resident and three staff. The photographs showed that a good time was had by all. The PCP file also had a communication dictionary in it. This explained ways in which the person likes to communicate. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People attend a day service if they want to, and are given some opportunities for leisure activities both at the home and out in the community. People help with household chores and eat the meals they enjoy. Evidence: An activities planner is in place which gives the minimum number of activities for each person. The planner includes activities such as swimming, music, DVDs, foot spa, hydro bath, massages, playstation, Wii, visits to family, and Bob the music man (who visits once a month). Staff told us they do extras when they have time and depending on what each person wants to do. They said when there are only three staff on duty there is little opportunity to do any activity. The acting manager said she is trying to find a way to evaluate whether people have enjoyed the activities. She also knows that more activities are needed so that people Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: can get out and about more than they have done. There is a house vehicle (mini-bus) which some staff drive: this is used to take people out when there are enough staff on duty. All six people who live at 18 Franklin Avenue attend day services outside the home on some set days each week. This means that on some days they get involved in going out into the community, doing activities, and meeting other people. They each have a communication book so that staff at the home and staff in the day service can let each other know how the person is getting on. All six people enjoy swimming. Unfortunately the home has only been able to get one slot a week at the local hydrotherapy pool, so people take it in turns to go swimming. There is a sensory room at 18 Franklin Avenue. On the days we visited the room was in the process of being refurbished. During our January visit the manager said she had arranged for the carpet to be fitted, so people would soon be able to use the room again. Some people are able to help with some of the household chores. For example, one person helps with the hoovering and dusting. Staff who like to bake cakes hold baking sessions in the kitchen and people help as much as they can. Some people enjoy helping to prepare the meals. We spoke with one person and her parents. Although she does not use words to communicate, her responses to our questions were very clear. This persons parents told us that she gets all her needs met. This person has all her food and drink through a tube directly into her stomach as she has difficulties swallowing. Her parents told us they were very impressed that the staff had worked hard, with all the relevant professionals, to try to get her back on normal food, but this had not been possible. They said staff take their daughter out a lot. She goes to church, swimming, out in the garden, shopping and so on. This person likes to have free time out of her wheelchair on the floor. This used to take place in the snoozelen room (where there is overhead tracking) but has not been possible since refurbishment of the room started. Staff told us she has a lot of free time when she goes home for weekends, and on the 3 days she goes to the day centre. While the snoozelen room is out of action, staff help her to bed a little earlier than usual so she doesnt sit so long in the wheelchair. The acting manager told us that they have six weeks of menus which have been put together based on peoples likes and dislikes. She said the menus have been changed recently to meet the Smile Award criteria. This means that every meal contains all the food groups, and the menus now incorporate more fresh vegetables, fish and fresh Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: fruit than they did previously. One of the residents is Hindu so does not eat beef or pork products. Two people have their food via a PEG tube so do not eat meals. Staff have worked hard with the speech and language therapist and the dietician and have found that one person, who hadnt tasted food for many years, is now able to eat small tasters of food each day, which he really enjoys. Care Homes for Adults (18-65 years) Page 16 of 30 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. People are supported with their personal care in the way they prefer, their health needs are addressed and staff administer medicines correctly and safely. Evidence: Care/support plans showed that people get the care/support they need, in the way they prefer. Some of the staff have worked with the people who live here for a very long time and have learnt how to recognise peoples different moods. They have worked out what people like/dont like and the detailed guidelines in the care plans reflect this so that care given is consistent. Four of the people who live here also have a communication passport. This details the way in which each person communicates, for example, how they show they are happy, in pain, enjoying something, and so on. The passports have been put together by people who know the person well, including their family, day service staff, and staff at the home, and people take these passports with them wherever they go. Each person has a Health Action Plan (HAP) in place. The Governments Valuing People document said that everyone with a learning disability would have a Health Action Plan in place by 2005. The HAPs we looked at had been reasonably well completed, but Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: each person also has a Health file where much of the information the Government expected would go in the HAP is kept. One persons health file confirmed that they see other health professionals when needed, such as seeing a dentist regularly at the day centre, the optician every 2 years, and the chiropodist. The acting manager said the chiropodist visits every 6 weeks, but not all the visits were recorded. The acting manager also said a dietician visits every 6 months, and has a telephone conversation with the home each month. People are weighed at least monthly, their weight recorded, and any concerns reported to the GP or the dietician. None of the people who live here are able to manage their own medication. Medication is provided by the local chemist in weekly dosette boxes. The chemist also supplies weekly Medication Administration Record (MAR) charts. We looked at the MAR charts for one person. These had been signed properly to show that people had been given their medicines as prescribed. We were not able to audit any of the medicines in their original packets because the chemist had made a number of errors on the MAR charts about how many tablets had been supplied, and staff were not recording any balances carried forward from one week to the next. However, staff do a check of the medicines 3 times a day at each handover. Care Homes for Adults (18-65 years) Page 18 of 30 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. People can be confident their concerns will be listened to, and that staff are trained to keep them safe from harm. Evidence: Relatives said they know how to complain if they need to and they were confident that any concerns they had would be sorted out. On one persons file we noted that the complaints procedure (in the licence agreement) was out of date: the manager said this is the one the person would have received when they first arrived. There is an up to date copy of the complaints procedure in the service user guide. The acting manager told us that everyone has had training in safeguarding vulnerable adults (SOVA). Telephone numbers for staff to report any issues were on the board in the office, plus a leaflet Alerters and Referrers guidance. The most recent copy of Lutons safeguarding policy had just been sent to the home. The acting manager demonstrated she was aware of SOVA policies and procedures: the day before our inspection she had referred one person to the SOVA team when staff discovered a couple of minor injuries to the persons skin. The manager said she also reports any allegations/concerns to her line manager. The home referred one person who lives here for a Deprivation of Liberty safeguarding (DOLs) assessment, as he needs a strap to prevent him slipping out of his wheelchair. The best-interests assessor said this did not require a DOLs authorisation. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Aldwyck Housing Association has announced it will be selling its care homes, including 18 Franklin Avenue. According to the acting manager, relatives and the people who live here have been kept informed about the progress of the sale, although at the time of the inspection there were no prospective buyers. The advocate who visits the home is also involved in making sure people understand as much as they can about the sale, and what this means for their future. None of the people who live here are able to manage their own money. A small amount of cash is kept for each person in the homes safe, and a record is kept of all money that goes in and out. On the first day of the inspection we checked the records for three people. We checked the maths as well as looking at whether the recorded balance, actual balance, and actual cash were all correct. We were disappointed to find that there were mistakes in the maths, and the cash in the tins did not match either the recorded balance or the balance that should have been there, for all three people. When we returned, someone from head office had visited the home and had sorted everything out. However, we recommend that a system be put in place in the home that does not rely on someone checking every few weeks, but that ensures it is correct all the time. Care Homes for Adults (18-65 years) Page 20 of 30 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. 18 Franklin Avenue offers a comfortable, homely, clean and well maintained home for the people who live here, which has the equipment people need. Evidence: 18 Franklin Avenue is a purpose-built bungalow in a residential area of Barton-le-Clay. The bungalow was built to accomodate people with complex needs, so has wide corridors and doorways so that people in wheelchairs can get around easily. Generally the whole home was clean, well decorated and well maintained, although on the first day we noticed a faint odour of stale urine in the entrance hall and lounge. People buy whatever they want for their own rooms, including bedding and towels, furniture and personal items such as a television or music system. Most rooms, including the bathrooms and the sensory room, have overhead tracking for a hoist, and there is a specialised bath which people like because it has spa jets. There is a sensory room, snoozelen, at 18 Franklin Avenue. Staff told us this room had been out of use for about 4 weeks because it was being refurbished. The acting manager said there had been a problem with the new carpet but it was due to be fitted the week after our second visit. The room would then be ready for people to use. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: There is a lovely garden to the rear of the bungalow which people use quite a lot in the summer, and there is some parking at the front of the home. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live here benefit from staff that are recruited well, and who have sufficient training, supervision and support so that they can do their jobs properly. However, there are not always enough staff on duty to make sure peoples needs for activities are met. Evidence: In the AQAA the acting manager wrote All the staff are hard working, respectful and have a good attitude towards the residents. We have some very experienced members of staff that know the residents particularly well. One of the staff said The staff are lovely. On both days we visited there were 4 staff on duty. Staff told us that usually there are only 3 staff, which is adequate for making sure peoples personal care needs are met, but not adequate for supporting people to undertake activities. Staff said that more staff are put on the rota if there are outings or activities arranged, or people have appointments to attend. There are two waking night staff to meet the personal care needs of people during the night. The acting manager told us that at the time of the inspection there were two staff vacancies, so agency staff were covering any gaps on the rota. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: The relatives we spoke with were very complimentary about the permanent staff, saying they are very good and they respect people. They were very impressed, and grateful, that the manager stayed with their daughter when she was in hospital, when they were not able to. They are happy that most of the staff at the home are permanent. However, they are also concerned about whether staff will stay when the home gets taken over. We looked at the records the home keeps about the staff. Aldwyck Housing Association came to an agreement with CSCI (now CQC) that the original documents collected about staff before they start work (such as written references, Criminal Record Bureau (CRB) checks, application form and so on) could be kept at their head office. A pro-forma which gives verified details about each staff member, including a photograph, must be kept at the home. The manager had been advised that she only needs to have the pro-formas in place for any staff who started work after 2007, so there was no information in the home about staff who had started work before this date. The acting manager agreed to get this put in place very quickly. In the AQAA the manager wrote that there are 15 permanent care workers at 18 Franklin Avenue, 12 of whom have a National Vocational Qualification (NVQ) in care. 2 staff are working towards achieving an NVQ. Staff we spoke with said they are offered lots of training and are all up to date with all the relevant courses. The acting manager said that in 2009 a number of videos were made available by the organisation for staff training. These were accompanied by a questionnaire which staff had to complete, and discussion. She said the home has signed up to the Health Protection Agencys (HPA) Infection, Prevention and Control training. This is due for completion by July 2010 but has all been put back by the HPA because of the national swine flu outbreak. The acting manager said that staff who need to have their training updated have been booked onto the relevant courses. Staff told us they have regular supervision with one of the 4 senior staff, and can speak to the acting manager at any time. They also have an annual performance and development review. The manager said each team member has targets/goals that they need to work towards. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 18 Franklin Avenue is a good home which is managed well, so that the people who live here have a good quality of life and are kept safe. Evidence: The acting manager, Joyce Joseph has worked at the home for a number of years, and completed the Leadership and Management course (which has replaced the Registered Manager Award) in June 2009. One of the staff said Joyce is a good manager - the home is definitely in safe hands. The acting manager is on the rota for all her shifts, so she does hands-on care and support as well as the management tasks. There is an acting deputy manager, and senior carers who all have delegated management responsibilities. The home has a number of ways to make sure a good quality service is being offered. A representative of the provider visits each month and writes a report which is sent to the home. Families are invited to complete a questionnaire each year and they are invited to a meeting at the home every 3 months. Advocacy Alliance is involved with the home to act, as do peoples parents, as advocates when needed. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Paperwork we looked at included a handover book. Each persons name is recorded each shift, and some brief information written to pass on to the next staff group. All this information is also written in peoples individual notes. We suggested to the acting manager that there are a number of reasons why this type of record (the handover book) is not recommended, including whether it meets data protection, and whether duplicated information is not only a waste of time but also could lead to information being left out. In the AQAA the manager told us that all the required policies and procedures are in place and most have been reviewed within the last three years. The home takes health and safety seriously. In the AQAA the manager confirmed that checks of all the equipment in the home (such as hoists, fire equipment, gas, and electrical appliances) have been carried out at the required intervals, and that risk assessments are in place. Staff have all received training in all the topics related to health and safety. They also take the risk of fire seriously. On the shift plan for each shift one person is nominated as the fire warden. Some of the staff have taken a fire marshall course, and all staff have done fire safety awareness training. We looked at the fire log which showed that the fire alarms are tested weekly, and the emergency lighting monthly as required. Staff also record that theyve made a visual check of other equipment, such as fire extinguishers (including in the house vehicle), fire blanket, and fire call points. The fire officer visited the home in October 2009 and made 3 requirements. The manager said that the issues are in hand: a gate is being fitted at the side of the bungalow so that the homes rubbish bins are not accessible to members of the public; a smoke detector is being fitted in the store room opposite the office; and a Dorgard has been purchased (but not fitted) for the office door. On the days we visited the office door was wedged open. The acting manager removed the wedge when we asked her to, and threw it in the bin. She said she would get the Dorgard fitted very quickly. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 42 23 The requirements of the fire service must be met. A gate must be provided to secure the rubbish bins. A smoke detector must be fitted in the store cupboard. Fire doors must only be held open by a means approved by the fire authority. So that people are protected as much as possible from fire. 28/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 23 33 34 A system should be introduced to make sure that residents money is always accurate. There should be enough staff on duty to meet peoples needs for activities and social stimulation. There should be information in the home for all staff, including agency staff, to show that all required preemployment checks have been carried out. Page 28 of 30 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 41 The acting manager should consider whether the use of the handover book is necessary, bearing in mind the discussion we had on the day of the inspection. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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