Care Home: 39 Beresford Gardens

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What the care home does well Residents benefit from living in a home that is run by a competent and experienced registered manager and their rights and best interests are safeguarded. The service provides all the information a person considering living in the home would want to know about facilities and what living in the home would be like. The service gathers a great deal of information about the individuals requirements and preferences prior to admission, not only to meet the diverse of the individual but to also ensure the home is able to meet their needs in a manner acceptable to the person. The service ensures that all members of staff receive relevant training that includes induction and external qualifications that is targeted and focused on improving outcomes for people living in the home. What has improved since the last inspection? Since the last inspection the cracks to walls have been repaired and some redecoration has taken place. A new storage cabinet has been purchased for the dining room. Further opportunities for activities have been introduced. What the care home could do better: There are no requirements arising from this inspection and we are of the opinion that the service continues to provide excellent quality outcomes for people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: 39 Beresford Gardens 39 Beresford Gardens Cliftonville Margate Kent CT9 3AG     The quality rating for this care home is:   three star excellent 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: Paul Stibbons     Date: 2 2 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 28 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 28 Information about the care home Name of care home: Address: 39 Beresford Gardens 39 Beresford Gardens Cliftonville Margate Kent CT9 3AG 01843221332 01843221332 beresford.gardens@theavenuestrust.co.uk glebe.house@theavenuestrust.co.uk Avenues Support Services care home 4 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 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 4. 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 39 Beresford Gardens is a spacious detached property situated in a residential area, within walking distance of the seafront, local shops and other amenities, including public transport. The home has four bedrooms, one of which is on the ground floor and accessible to wheelchair users. There is a small front garden and a rear garden, with lawn, garden seating and a swing. The home provides residential care in a homely environment for adults with varying degrees of learning disability and has facilities to adequately accommodate one adult with physical disabilities. The level of care and support given is very individual and based upon a full assessment of needs. The fees for each service user are set during the assessment process and are determined Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 4 Brief description of the care home according to the needs of the service user, the level of support needed and the staffing numbers required. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on the 20th February 2007. This Key unannounced inspection visit was conducted over a period of 3 hours from 12:00 until 15:00 on the 22nd January 2010. Prior to this inspection visit we assessed any information that we have received about the home and the information the service submitted in their Annual Quality Assurance Assessment that we had requested. The Annual Quality Assurance Assessment is a self-assessment by the service that focuses on how well outcomes are being met for people using the service. Care services are judged against outcome groups. They allow us to judge how well a provider delivers outcomes for the people using the service, rating them as Excellent, Good, Adequate or Poor. One overall judgment is made for each of the outcome areas. Care Homes for Adults (18-65 years) Page 6 of 28 This judgment is based on the standards looked at during the inspection process. Further information about how we make our judgments on outcome groups can be found in the KLORA (Key Lines of Regulatory Assessment) publication on the commissions website. The Deputy manager was present during the inspection and a number of staff members were observed and spoken with before the conclusion of the visit. Discussions were held with those present and a variety of documents and records that included Statement of purpose, Service user guide, pre-admission assessments of need, care plans, health plans, risk assessments, activity records, recruitment and training records, medication records and health and safety records were examined. A tour around the premises was undertaken to assess whether the facilities and quality of the environment met the needs of people who live there. The interactions between staff, management and residents were observed and noted. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have sufficient information on which to base an informed decision as to whether the home can meet their needs. A comprehensive assessment of needs is carried out prior to admission to ensure the home can meet prospective residents needs. Evidence: We wanted to look at the information available to people who may be considering using the service and whether it was sufficient and detailed enough to be able to make an informed decision as to whether the home would meet their requirements. We also wanted to see whether the home gathered sufficient information about prospective residents to be confident that they are able to meet the diverse needs of individuals in a manner that is acceptable to them. Although there have been no new admissions to the home, it is evident from the information gathered about people already supported by the service, that significant time and effort is spent planning to make admission to the home personal and well Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: managed and prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. The home has developed a statement of purpose and service users guide, which is very specific to the resident group and gives the individual all the information about the home that prospective residents would want to know. All new residents receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. The service is highly efficient in obtaining a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of the care plan before admission. The assessment focuses on achieving positive outcomes for people and this includes ensuring that the facilities, staffing and specialist services provided by the home meet the ethnic and diversity needs of the individual. The service does not offer intermediate care. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from having an individual plan of care that reflects their assessed and changing needs. People living in the home are consulted and supported in taking risks as part of an independent lifestyle. People living in the home can be confident that information held about them is handled appropriately and their right to confidentiality is upheld. Evidence: We looked at three care plans because we wanted to know whether people supported by the service had their personal and health care needs met and that they make their own informed decisions and have the right to take risks in their daily lives. The home has enabled communication by developing comprehensive communication passports using pictures to support the written word. The communication passports Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: describe in detail how the person wishes to be supported by staff members. The care plans viewed are person centred and include a holistic profile that gives insight into the individuals background, their past and current abilities and how to build upon their strengths. The key principle of the home is that people supported by the service are in control of their lives and they direct the service. Staff members are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. The care plan includes a comprehensive risk assessment, which is regularly reviewed. The service has a can do attitude and risks are managed positively to help people supported by the service lead the life they want. Any limitations on freedom, choice or facilities are always in the persons best interests. The privacy of people supported by the service is safeguarded by secure storage of information and a confidentiality policy that staff and other health care professionals adhere to. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have a range of opportunities that will meet their social, leisure and educational needs and their own personal development. People living in the home are supported in maintaining appropriate relationships with friends and family. People living in the home enjoy a healthy and varied diet that is of their choosing. Evidence: We wanted to know if people supported by the service are supported to lead a lifestyle according to their individual preferences. We looked at the care plans and activity records of three residents and it was evident that central to the homes aims and objectives is the promotion of the individuals right to live an ordinary and meaningful life in both the home and the community in a way that is directed by the person Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: supported by the service. People supported by the service access a day centre and have opportunities to enhance their daily living skills and access the local community. Examples of activities participated in included, cinema visits, shopping trips and the day centre where people can be involved in social groups, gardening groups, arts and crafts and swimming sessions. In house activities included TV programs, music, aromatherapy and a sensory room. Daily reports and activity lists confirm activities, independent tasks and choices made by people supported by the service. The service actively encourages people living in the home to maintain contact with family and friends by contributing to a newsletter that is circulated to them. People supported by the service are encouraged to make choices around meals by the use of picture cards. Menus viewed indicated a balanced and nutritious diet. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive personal support in the manner they prefer and require and their physical and emotional needs are met. People living in the home are protected by the homes policies and procedures for dealing with medication. Evidence: We wanted to see if people supported by the service had their physical and emotional health needs were met safely and in a manner acceptable to them. We looked at three care plans and the homes procedures for dealing with medication. The records viewed indicated that staff and management are highly aware that the way in which support is given is a key issue for people living in the home and individual support plans clearly record peoples personal and health care needs and detail how they will be delivered to the individuals wishes. Health action plans and appointments checklist are in place and reviewed monthly by keyworkers for any changes. There is evidence in health records of referrals to other health care professionals. The home has developed efficient medication policy, procedure and practice guidance. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Staff members all have access to this written information and understand their role and responsibilities. We examined the procedures for managing medication and the storage and administration is in accordance with current guidelines and legislation. Medication records are seen as key to the efficient management of health care matters and the home consistently keeps them up to date. All staff members required to administer medication have received training in safe medicine administration. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their views will be listened to and acted on and they are protected from abuse and neglect. Evidence: We wanted to know whether people supported by the service were enabled to raise concerns they may have about their treatment and whether they felt at ease in doing so. Observations of interactions between staff and residents indicated that the home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. The service has a complaints procedure that is clearly written and is in pictorial format. The home has received only one complaint since the last inspection and three compliments. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Discussions with staff members on duty demonstrated that they know when incidents need external input and who to refer the incident to. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Records viewed evidenced that the training of staff in safeguarding vulnerable adults is regularly arranged by the Home. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People supported by the service live in a homely, safe and comfortable environment with sufficient personal and communal space to meet their needs. Evidence: We wanted to see the environment in which people supported by the service live in and as to whether the facilities promoted their independence. A tour of the premises evidenced ample communal and personal space for people living in the home with a private area for individuals to meet with family and friends. Communal areas are reasonably maintained and two bedrooms viewed had personal items on display and reflected the lifestyle and interests of the occupants. The home is clean and tidy and the AQAA states that all staff members receive training around health and safety, fire awareness, infection control and moving and handling. There is evidence of health and safety audits that include food hygiene, water, medication and the control of substances hazardous to health. Moving and handling assessments have been carried out and the specialist equipment Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: to maximize independence has been provided. Since the last inspection the home has purchased a new cabinet for the lounge and the AQAA states there is a plan to replace furnishings and white goods during the next 12 months. The cracks in the walls identified in the last inspection have been repaired although there still remain areas that would benefit from redecoration. There is a reasonable sized garden containing a swing, flower beds and garden furniture. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by a competent and qualified staff team in sufficient numbers to meet their needs. People living in the home are protected by the services robust recruitment procedures for new employees. Residents individual and joint needs are met by an appropriately trained and supervised staff team. Evidence: There is consistently enough staff available to meet the needs of the people supported by the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for people supported by the service and is not led by staff requirements. Staffing rosters viewed evidence that in addition to a manager/deputy on duty there are four staff members on duty during the day. All staff receives relevant training that is focused on delivering improved outcomes for people supported by the service. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. The Annual Quality Assurance Assessment states Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: that over 83 of staff members have an NVQ qualification in care. There is a good recruitment procedure that clearly defines the process to be followed with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. One new employee spoken with during the visit confirmed that this procedure is followed in practice Evidence was seen that staff meetings and Supervision sessions are regular and staff find them helpful with a focus on improving outcomes for people supported by the service. Notes and action points are taken of meetings and sessions, and progress is regularly reviewed. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People supported by the service benefit from living in a home that is run by a competent and qualified manager and where their rights and best interests are safeguarded. People supported by the service benefit from living in a home where their views underpin all self-monitoring and development of the home and their health, safety and welfare is promoted and protected. Evidence: The registration certificate for the service is displayed and correct in its detail. A current certificate of insurance for employer liability and business loss is also displayed. The registered manager of the home has a clear understanding of the key principles and focus of the service, based on organisational values and priorities and they are working to continuously improve services. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: There is a focus on person centred thinking, with people supported by the service shaping service delivery. The registered manager is experienced with the relevant qualifications and leads and supports a staff team who have been recruited and trained to a high standard. The AQAA was returned to the commission when we asked for it and contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The service has sound policies and procedures that are reviewed and updated in line with current thinking and practice. The home works to a clear health and safety policy and all staff members are fully aware of the policy and are trained to put theory into practice. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The home has sought to monitor quality of the service provided through feedback from service users, relatives and internal Regulation 26 visits by senior management. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 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. 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