Care Home: 288 Shipbourne Road

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What the care home does well The home offers excellent person centred care that is tailored to individual needs. There is a good care planning process that identifies changing needs and considers new ways in which these needs can be met. There is a wide range of age appropriate activities both within the home and the local community. The people who live in this home are encouraged to participate as nay activities as possible. The people who live in this home are supported to keep in touch with friends and relatives and to welcome them to parties and meals at their home. The home positively promotes the health and well being of the people who live there. Their health needs are clearly identified and met. The home supports the people who live there to maximise their autonomy and independence so they are able to make appropriate decisions about the way they live their lives. There is a stable and dedicated staff team who put the needs of the people who live there first. The home is well managed at both a local and organisational level. There are excellent quality assurance procedures that ensure the standards of care and the environment are maintained to a high standards and that there is a culture of continuous improvement. What has improved since the last inspection? The Person Centred Plans have been reviewed and re-organised to make them easier to use and to improve confidentiality. More work has been done on a pictorial guide to help the people who live in the home make clearer and better informed choices about what they would like to eat. A folder has been prepared for each person that gives good information about their needs in a clear and straightforward way. This folder is to be used to give information to hospital staff about care needs should any person need a hospital admission. The home, in conjunction with the Avenues Trust, has done a lot of work to help the people who live there cope with illness, aging and dying. Everyone now has a simple document in their files that states what their wishes are about end of life issues. What the care home could do better: The home, in conjunction with the Trust, should review and re-write the policies and procedures for medicines that are to be taken when away from the home. These policies should be made clearer and local policies and risk assessments should be considered for exceptional circumstances. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 288 Shipbourne Road 288 Shipbourne Road Tonbridge Kent TN10 3EX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Mills     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.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: 288 Shipbourne Road 288 Shipbourne Road Tonbridge Kent TN10 3EX 01732773460 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Avenues Support Services Name of registered manager (if applicable) Ms Amanda Higglesden Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home 288 Shipbourne Road provides residential care and support to six adults with a learning disability and other associated needs. The home is within walking distance of local shops and library. The home has a vehicle equipped with a tail lift for wheelchair users. It is only a short journey to Tonbridge town centre with all of its amenities. All of the rooms are single and have en suite toilet facilities. Two rooms also have en suite showers. There is a large lounge/dining room and a lift to the first floor. The home has a room for private visits. There are car parking spaces at the front of the Care Homes for Adults (18-65 years) Page 4 of 30 care home 6 Over 65 0 6 Brief description of the care home building. Further information about the home can be requested from the home manager. Care Homes for Adults (18-65 years) Page 5 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This visit formed part of the annual inspection process of the Care Quality Commission (CQC) under the Care Standards Act. Information gathered during this visit as well as information, such as notifications of any incidents seriously impacting on the lives of people who use this service; and information we have received from other people such as relatives and health and social care professionals. During this visit we spoke to four of the people who live in the home and two of the staff who work there. This was to find out what they thought about the quality of the service. We also looked at some of the documentation that the home keeps. This included a sample of the Person Centred Plans (PCPs) that give information about the way care should be given, some written policies and procedures and records about Care Homes for Adults (18-65 years) Page 6 of 30 health and safety in the home. A tour of the home was made and direct and indirect observations were made throughout the visit. We have used all the evidence gathered to give the home a star quality rating. The views of everyone spoken to were very positive. The people who live in this home all looked relaxed and comfortable and one said, I like it here, theyre all nice. Staff said that there is a happy atmosphere in the home, that the needs of the residents are put first and that everyone works well together. The people who live in this home, the staff, manager and area manager are all thanked for the welcome they gave and for their help throughout this visit. The star quality rating for this service is 3 stars. This means that the home is judged to be excellent. What the care home does well: What has improved since the last inspection? What they could do better: The home, in conjunction with the Trust, should review and re-write the policies and procedures for medicines that are to be taken when away from the home. These policies should be made clearer and local policies and risk assessments should be considered for exceptional circumstances. Care Homes for Adults (18-65 years) Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home gives the people who use this service and their supporters excellent information about the home and their rights and responsibilities whilst living there. This means that they can make an informed choice about moving into the home, Thorough pre-admission assessments are made to ensure that only those people whose needs can be met and who are suitable to live in the home are offered a place. Evidence: The home has a clear Statement of Purpose and Service User Guide. The new manager has done further work on developing the information for the people who use this service in a way that they can understand by adding more pictures to these documents. There is a notice board in the hall of the home with information about inspection and events going on in the home and in the local community. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: It is clear that new residents will only be admitted after a detailed assessment process which includes getting information from representatives of the placing authorities. The admissions process is very thorough. Once a referral is received the home manager and the area manager scutinise this. If it appears that the person is suitable to live at the home then they visit the prospective service user in their current placement. A comprehensive written assessment is made and then there are a series of visits to the home, including an overnight stay if wished. The home is currently planning to admit one new person. The pre-admission documentation for this was examined. This showed that the home has made every effort to ensure that the needs of the prospective service user can be met, that there has been good preparation for the admission and that the other residents in the home have had an opportunity to take part in this process. The new resident has already been able to choose the colour scheme for their room. Care Homes for Adults (18-65 years) Page 12 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. The home positively promotes informed decision making and offers a lot of choice so that the people who use this service can gain as much independence as possible in all aspects of their lives. Evidence: The people who us this service all have individually drawn up person centred plans (PCPs). These are important documents as they are one of the means by which the individual service user and their supporters can be sure that their needs will be met in the way they would like. Also they are an important reference for the staff who support their needs. The person centred plans contain comprehensive information about each service user. They identify likes and dislikes, cultural and religious needs and health and social care needs. The plans describe the way these needs are to be met in detail. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Direct and indirect observation showed clearly that the people who use this service are able to make appropriate choices about their daily lives. These choices include what they might like to eat, how they spend their time and which household tasks they help out with. Since the last inspection more work has been done on the pictorial guide that is kept in the kitchen. This guide contains pictures of meal choices and there is now much more detail in this. For example, should a service user make a choice of fish for their meal, they can then look at a second stage of pictures of different types of fish and different ways of cooking it and make further choices about the meal they are to eat. Independence is considered an important part of the support provided at the home and there are lots of examples of the way the home promotes independence, from the provision of specialist equipment to encouraging the people who use this service to become involved in understanding their medication needs and taking as much responsibility as they are able for their own medication. Best interest meetings are held on behalf of those people who are not able to make informed choices about wider issues such as health care. the manager showed a very good understanding of the Mental Capacity Act and the implications it has on decision making. Care Homes for Adults (18-65 years) Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a wide range of activities both within the home and in teh local community so that the people who use this service can live interesting and meanigful lives. Evidence: The home offers plenty of choice of activities and the PCPs show that these are individually tailored and reviewed on a regular basis. The people who use this service are in the older age group and activities that are on offer are age appropriate. The home has a very positive atmosphere and all the service users are enabled and encouraged to take part in appropriate activities both within the home. These include household chores, gardening and music. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: The people who use this service also make excellent use of the facilities in the local community. Some attend day opportunity centres and clubs such as Age Concern. Others go out to visit local pubs and shops. Currently the possibility of one service user being able to take on some paid work is being looked into. The cultural and religious needs of the individual service users are noted and met. Some service users are regular church goers and one is able to do this without the support of the staff at the home as members of the church provide help for this. The home is very good at helping the service users to maintain contact with friends and families. One resident has recently celebrated a birthday and a party was held in the home. Many friends from the clubs she attends came to the party. The home arranges for holidays and visits to families. One resident is supported to visit family abroad and the home has contacted other families to ask for background information. Service users are supported to use the phone and use is made of the e-mail system to maintain contact. Daily plans are in place for each person. These contain clear guidance for staff about routines, preferences for personal care and any particular support needs for eating. Appropriate risk assessments are in place for activities and the environment in which they take place. The home promotes healthy eating and monitors nutrition well. There was plenty of fresh and nutritious produce in the home on the day of this visit. As mentioned in the previous outcome area, the home has done a lot of good work in developing a guide to help the people who use this service to make better informed choices about the food they eat. Everyone who is able and wishes takes part in menu planning, food shopping and meal preparation. Notes of preferences are made for those people who are unable to do this and these preferences are then taken into consideration when menus are planned. involves everyone in the menu planning. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home works very hard to ensure the people who use this service maintain good health, that they are valued and that their privacy and dignity is respected. Evidence: The Person Centred Plans (PCPs) are being reorganised into three separate files. One for health, one for personal support and life history and one for finance. This will make it easier for staff to find the information they need and improve confidentiality as some files will not need to be seen by all staff. The home has also prepared individual files that contain essential information should a service user need to be admitted to hospital. These documents are brief but give hospital staff the information they need to help them care for the person. There is information about medication, communication, likes and dislikes and any special needs such as dietary requirements and feeding support needs. Health needs are clearly identified in the PCPs. These records show that appropriate professional advice is sought on behalf of the people who use this service. The Kent Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Association for the Blind (KAB) has been contacted for advice about visual impairment, and physiotherapy and occupational therapy advice has been sought for those with mobility problems. The home maintains excellent relationships with the local GP practice. The home manages nutrition very well. Healthy eating is encouraged and specialist feeding needs are noted in the PCPs. Staff encourage a good fluid intake and there are clear procedures in place should any concerns about nutrition be noted. On the day of this visit all the people who live in the home were in good health and appeared very well nourished and had clear and healthy looking skin. The home operates a key worker system. This means that each service user has a named staff member who takes responsibility for ensuring that PCPs are updated and that their support needs are met. The key workers speak up for the people who use this service at meetings and reviews if they are unable to do this themselves. Medicines are stored safety and at the correct temperatures. The home has a small medication room with medicine cupboards that meet the required standards. The Nomad system is used. This means that the pharmacist prepares the medicines for each person in monthly cassettes. Staff who administer medicines have all had appropriate training in this process. Whilst no one is able to self medicate, the home encourages those who are able to take as much responsibility as possible in the medication process. One service user is able to take his lunchtime medication independently and another is able to go to the medication room at the correct time to receive his medication. The home is commended for the work they have done to promote independence in this aspect of care. There are sound policies and procedures for the management and administration of medicines in the home. These are common to all homes operated by the Avenues Trust. There is one section in the procedures when medicines need to be taken when away from the home and one paragraph in this section is ambiguous. It does not make it clear as to whether the procedure is for the cassette should be taken away from the home or if the tablet for that particular time of day is to be taken out of the cassette. The latter could be considered as secondary dispensing and would need to be risk assessed. In addition the policy does not refer to any local procedures that might be in place in these circumstances. It is recommended that the Trust review this part of the policy an rewrite the relevant section so the procedures are made more clear. The home, in conjunction with the Avenues Trust, has done a lot of work in dealing with aging, illness and death. The people who use this service are all in the older age group. Since the last inspection, one service user has passed away. This caused great Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: sadness to everyone in the home. The home detailed the efforts made to assist the person to visit their favourite in the months before their death and how they were able to arrange a funeral that reflected the individuals wishes and religious background. The manager said, The send off was just what they would have wanted - the Salvation Army, their favourite hymns, readings by staff and - best of all- the Salvation Army banner was carried in front of the coffin. Bereavement counselling had been arranged for everyone in the home who wanted it and memory of this person is kept alive in conversations, photographs and mementos. It was evidenced that this has been a great comfort to his particular friends who lived in the home. Each person now has a document called, When I die, in their PCP. This is written in a simple way and helps the people who use this service to talk about, and record, their wishes should they become seriously ill. It also details their wishes about their funerals. Where a person does not have the capacity to do this the written plans show good evidence that the next of kin have been consulted to ensure wishes are respected. The Trust and the home are commended for the positive work they have done in dealing with the sensitive issues of illness, aging and death. Care Homes for Adults (18-65 years) Page 19 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. The home has sound systems for dealing with concerns, complaints and safeguarding. It listens to, and acts on, the views of the people who use this service and works to protect them from harm. Evidence: There are sound policies and procedures for handling concerns, complaints and safeguarding issues. Day to day concerns are dealt with as they arise. There have been no formal complaints since the last inspection. Observation showed residents to be content and able to do as they wish whilst at home. Staff said that they would always be prepared to raise a concern on behalf of a service user. Staff have received training regarding safeguarding adults and the organization has a range of relevant policies and procedures. Staff spoken to were clear about their responsibilities to wards the service users. They are aware of the need to report any concerns in respect of suspected abuse and understand the procedures for this. Best interests meetings are help for those who are unable to express opinions for themselves and there is good communication both within the home and with relatives, outside agencies and health and social care professionals. Care Homes for Adults (18-65 years) Page 20 of 30 Care Homes for Adults (18-65 years) Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is well maintained, clean and safe. The home is a pleasant and homely place in which to live. Evidence: The home is a two story house that was purpose built. It is suited to people with physical and learning disabilities. The home is well maintained, light and airy. There is an open plan lounge dining room and corridors and doorways have extra width to accommodate wheelchairs. The bedrooms all have en suite facilities and are decorated to reflect the tastes and interests of the individual service user. There are wide stairs with rails on either side and a shaft lift that give access to the first floor. The layout of the home allows those with mobility problems to maintain as much independence as possible. The home has obtained the specialist equipment necessary to assist those with physical disabilities. The garden at the front would benefit from some attention. The manager said that there are plans to replace some of the flower beds with grass and to put more potted plants there as this would enable the service users to become more involved. The rear Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: garden has a patio and barbeque area and a new greenhouse has been purchased as one service user particularly enjoys gardening. The home was very clean and homely on the day of this visit. There are sound infection control measures in place. The laundry is well equipped and there are good procedures for ensuring that laundry is dealt with correctly. Care Homes for Adults (18-65 years) Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels, staff training and staff recruitment practices are all excellent. Staff morale is good and there is excellent team working. This ensures that the people who live in this home are cared for by a well qualified, cheerful and dedicated staff team. Evidence: There is a very stable staff team. Since the last inspection the registered manager has retired and a new manager and deputy have been appointed. The Homes Annual Quality Assurance (AQAA) told us that there is a good age, skill and gender mix amongst the staff who come from diverse cultural backgrounds. The manager said that this enhances life in the home as staff bring different ideas and skills to their work. Examination of the staff roster showed that there are three staff on duty during the day. Staff said that this is sufficient to meet the needs of the service users. There is flexibility in the staffing rosters and extra staff are put on shift if there are additional support needs such as holidays, special occasions or increased service user need due to illness. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: The Avenues Trust strongly promotes staff training and has sound systems for monitoring this. Nine staff have achieved the National Vocational Qualification (NVQ) in care at level two or above. Three staff have the NVQ at level two, five at level three and one, excluding the manager, has the NVQ at level four. Training records are held on staff files in the home and the deputy manager takes responsibility for overseeing training at local level. The new training year has just begun and the deputy manager said that one of her main priorities in the next month will be to get the training plan in place for this year. The Avenues Trust has very robust recruitment policies and procedures. It deals with the administration for the recruitment of new staff from the Trust head office. This ensures consistence and that the legal requirements for recruitment of staff are complied with. The home has tracer cards with details of CRB numbers, confirmation that written references have been received and that health checks are carried out. The Trust and the home are currently working on improving service user involvement in the recruitment process for new staff. There was some good discussion with the area manager and the manager about how this might be achieved. They said that they want to involve service users at every stage, from the decision to recruit new staff and the design of the job advert to the interview process. Staff spoken to clearly understand their roles and responsibilities whilst working in the home. They said that there is a good working atmosphere, that they receive regular supervision and that there is excellent team working. They said that they enjoy working in the home and that there are very good training opportunities. Care Homes for Adults (18-65 years) Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who live there. The home has shown sustained good outcomes for the people who live there, this, in line with CQC policy, assures us that they provide an excellent service. Evidence: The Avenues Trust is the registered provider for this home. The Trust is a not for profit organistation that provides residential and domiciliary care services for people over the age of eighteen with a learning disability that may also include a physical and/or sensory disability. The Avenues Trust is a well established organisation with many years experience in this type of care. The Trust has a good record of providing high quality care. Since the last inspection the registered manager has retired and a new manager has been appointed. Her application to register with the Commission has been accepted and, at the time of this visit, she was waiting to undergo an interview to confirm her Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: suitability to register. She is well qualified for the post. She is a qualified nurse for people with learning disabilities and is registered with the Nursing and Midwifery Council (NMC). She also holds the National Qualification in Care at level four and the Registered Managers Award. She is a qualified NVQ assessor and has worked for many years in different care situations with people with learning, sensory and physical disabilities. Before taking up the post as manager in this home she was the deputy manager at another home within the Avenues Trust. Staff spoke very positively about the way the home is managed. They said that the Trust is a good employer and that their ideas and concerns are listened to and acted upon appropriately. The Trust and the home have excellent quality assurances processes. The area manager makes frequent visits to the home and makes thorough inspections, talking to staff and service users and ensuring the environment is up to standard. A comprehensive monthly report is produced that includes the welfare of the people that use this service and the views of their supporters. Staff at the home spoke very highly of the manager and area manager. They said there is an open and honest management culture and that both managers are very supportive and approachable. In addition, relatives and other stakeholders such as health and social care professionals, are sent surveys to find out what they think of the home. There are sound health and safety policies and procedures and records show that there are regular checks made to make sure the environment remains safe at all times. Care Homes for Adults (18-65 years) Page 27 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 28 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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