Care Home: 5 Ashley Avenue

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What the care home does well Staff are good observers and listeners and make sure that any thing they note or is raised in conversation is acted upon. Service users are supported to go out into the community and pursue their chosen leisure activities. They can go out individually with staff or in a supported group to lots of different places of interest. Staff make sure that residents receive good healthcare. The home is well managed with residents best interests at the heart of whatever they do. What has improved since the last inspection? Individual Life Plans have been successfully introduced within the organisation this year. The staff team aim to support the service users at No5 to have more input and understanding of their own plans by using Makaton, pictures and symbols. A consistent approach to supporting and managing service users has given them more opportunity to enhance their community presence. More robust staff interview and induction processes have been introduced to monitor and ensure the individuals suitability for the task, home and service users. Arrangements for medication storage have been improved. What the care home could do better: There were no requirements or recommendations identified at this visit. The home`s own quality assurance system monitors progress and performance on a regular basis and we were assured that any areas identified for improvement are addressed without delay. We understand the home is seeking to improve the weekend level of support to ensure choice is not compromised if people wish to go out individually. Key inspection report Care homes for adults (18-65 years) Name: Address: 5 Ashley Avenue 5 Ashley Avenue Folkestone Kent CT19 4PX     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: Geoffrey Senior     Date: 1 2 1 1 2 0 0 9 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 26 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 26 Information about the care home Name of care home: Address: 5 Ashley Avenue 5 Ashley Avenue Folkestone Kent CT19 4PX 01303252787 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): andrew_proactive@hotmail.co.uk Blythson Ltd Name of registered manager (if applicable) Miss Sarah Jayne Davidson Suggett Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3. The registered person may provide the following category 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 5 Ashley Avenue is one of four care homes operated by Blythson Ltd. in Folkestone. They are also known as Proactive Development. No5 provides personal care and support for three residents with significant learning difficulties. The home is a three story semi-detached house situated in a quiet avenue near to the shops at Cheriton. It is well maintained and tastefully furnished. Accommodation for the residents is on the first and the second floors and there is office space on the top floor. There is a small front garden and a larger back garden with parking space. There Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 3 Brief description of the care home is also on street parking in the vicinity. The fees for this home range between £1,500 and £1,860 per week and are based on the assessed needs of the residents. For more detailed information contact the service directly. Care Homes for Adults (18-65 years) Page 5 of 26 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 report takes into account information gathered since the last key inspection on 09.01.2007 and includes a visit to the home. The visit to the service was an unannounced Key Inspection which took place over one day. We arrived at 2:00 pm on 12.11.2009 and stayed for about three hours. The homes Registered Manager, 2 members of staff and the 3 service users were involved in the inspection. We received the homes annual quality assurance assessment, known as an AQAA for short on the day of the visit. This is a document that all homes have to send us once a year to tell us how they think they are meeting the national standards, how they have improved in the previous year, what they aim to do and lets us know when they have completed important environmental safety checks. We also contacted relatives of the service users for their comments on the service Care Homes for Adults (18-65 years) Page 6 of 26 provided by the home. The responses were noted and contribute to this report. At the time of the visit there were 3 service users living at the home. We observed how staff interacted with service users during the day when offering care support and had discussions with the manager and the staff on duty. We found out about the way the service users individual support plans and risk assessments are agreed and recorded. We also looked at and discussed the training records and quality assurance arrangements. Care Homes for Adults (18-65 years) Page 7 of 26 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 26 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 26 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. People who are interested in living at No5 will have a thorough assessment to make sure this is the right home for them. Staff will have the right skills to support people living at the home meet their needs. There is good information about the home to help people decide about moving in. Evidence: Prospective service users and their family can learn about the home from the written information that is made available to them. It tells them all about No5 and what to expect if they decide to move in. The use of pictures and photographs of the rooms, communal areas and garden makes it more meaningful. It tells the person lots of things, for example, about the staff, what support they can expect, their rights, things that they are responsible for and it explains about the home routines. We spoke with the manager and staff on duty and found that they clearly understood the importance of getting as much accurate information as possible prior to admission. The service user assessments that are in place brought together the work and support plans from previous placements, resource centres as well as care and health professionals. We saw that individuals wishes and feelings had been noted and Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: supported and, where there were behaviours that were difficult to support, guidelines were in place. People are offered the opportunity to visit the home, prior to admission, to meet and spend time with the people who live there and the staff. They can also look around the home and their bedroom and find out about what sort of lifestyle they could expect to experience if they choose to move in. We spoke to family members who said that they had been given opportunity to visit the home and had met with the staff. They said that the transition process had been handled wonderfully. They are happy with most aspects of the home and are kept up to date with any progress or developments. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having their own plan of care that shows their assessed needs and wishes. Staff and service users work together to make sure these are met. Service users are encouraged and supported to make their own choices and decisions. They are supported to take reasonable risks and develop their life experiences. Evidence: Staff have got to know each person well and have found out and recorded what support they need and how they like it to be offered. Some routines have been established and guidelines have been written in the support plans so that every one is doing the same thing. The files we saw were person centred. They reflected, as far as possible, the service users involvement and covered areas that are important to the individual. Things such as daily routines, things they need reminding about, where they need encouragement and where support is needed. Religious and cultural needs are noted to make sure any related things are known, and plans are put in place to make sure the persons wishes are respected. We saw from the records and were told by staff, that the support plans are regularly up dated Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: as people develop and their needs change. Relatives of service users told us how the home keeps them informed of progress and will always consult them before making any major changes to the way they provide care and support. The support plans contain thorough risk assessments. These are seen by the home as ways of supporting people to do things safely rather than as a reason to stop something. Care Homes for Adults (18-65 years) Page 13 of 26 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 benefit from being supported to live fulfilling lifestyles within the home and the wider community. They are helped to take part in activities that enrich their lives and widen their experience. Service users are helped to stay in touch with their family and friends. A good variety of balanced meals are available to the service users. Evidence: Staff told us that people were active in the home and were always out and about doing various things that interest them. There are activities scheduled for inside and outside the house. The weekly planner is used so that people know who is doing what and the levels of support that are needed. Communication between the staff and service users was easy going and informal. Differing forms of communication were used so that everyone was included in the interactions and could communicate their opinions and choices. People are helped to keep in touch with members of their family. Family and friends Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: are welcome to call. We spoke with service users family and they confirmed that staff contact them to tell them how things are going. They also said that the home asks them for their comments and opinions whenever a review is due or when there are any changes in circumstances. One family member said that they receive a monthly newsletter and photos telling them about progress and updates and things that have been going on in the house. The group of service users have all lived at the home for some time and the staff have got to know their food preferences and dislikes. Support workers do most of the cooking but everyone is encouraged to do their bit to help in the house. There is a weekly menu plan but this can be changed if people want something different. Everyone is encouraged to try new foods and they may also have a weekly take away of their choice. Care Homes for Adults (18-65 years) Page 15 of 26 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. People who use the home have their health and personal care support needs thoroughly assessed. Staff support is based on knowledge of the individuals and their condition. Systems are in place for the safe storage and administration of medications. Evidence: The home has conducted personal and health care assessments and have clear support plans based on the identified needs. The staff confirmed that they have clear guidelines on the maintenance of privacy and dignity when offering support. Specialist support is used when necessary and recommendation from these sources is followed. The management systems monitor individuals well being and update how health care needs are being met. They are discussed at handovers and meetings to inform staff of any necessary changes. One relative said that she is kept up to date with all health care issues and receives feed back from any specialist appointments. The manager reported that some healthcare interventions require specific permissions that are not always given however, ongoing monitoring and observations are in place to ensure the service users well being remains paramount. Staff reported that even though there are some quite complex support needs Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: everything is done to ensure these do not get in the way of the individual having an ordinary lifestyle. We looked at the storage arrangements and records for medication. These were satisfactory and up to date. New and improved storage facilities have been purchased and are in place and in use. Staff who are involved with medication receive training and have their competency assessed by the provider. We were told that risk assessments indicate that none of the current service users group can manage their own medication. Care Homes for Adults (18-65 years) Page 17 of 26 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. Service users and their representatives are supported to make a complaint or express a concern. The management and staff make sure that any concerns are listened to and sorted Evidence: The home has revised its written complaints procedure to now include pictures and symbols to make it more meaningful to everybody. This is discussed with service users and their family when they first come to live at the home and a general copy is available for visitors to the home. Staff have received training in the protection of vulnerable adults and were clear in their explanation of what they would do if they had any cause for complaint or concern.They said that they would seek to resolve any thing that caused distress to the service user and try to reassure them. The AQAA told us about the outcomes of complaints or safeguarding issues raised in the last 12 months. Care Homes for Adults (18-65 years) Page 18 of 26 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. Service users benefit from living in a home that is well maintained, clean and comfortably furnished. The furnishings and layout provide a homely environment. Evidence: The house is a homely place and appears clean and tidy. There is little to indicate that it is a registered care home either inside or out. Fixtures, fittings and flooring are kept in good condition. The manager spoke of the ongoing programme of redecoration and refurbishment which was evident at this visit. Service users have their own room that is furnished according to their needs and preferences. We were invited to look at some of the rooms and saw that they had been personalised to reflect the individuals interests and lifestyle. Service users can access all areas of the house without restriction. The enclosed garden is well maintained and has equipment for leisure and relaxation. Care Homes for Adults (18-65 years) Page 19 of 26 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. Recruitment procedures are sound and protect service users. Staff receive induction and training to help them do their job properly. There are sufficient staff on duty to support service users with their daily care and recreational needs Evidence: We talked to the manager about staffing in the home and looked at the staff duty rotas. We were told that there is an average of two support workers on duty, plus the manager on weekdays. We saw that rotas are worked out to cover for staff training and residents activities. The shift pattern is clear so that service users have a good idea who will be supporting them at any given time. Staff appeared to be well motivated to support service users and were seen listening and responding to them in a calm and patient manner. They spoke about how they communicate with each other and use the guidance in the care support plans to ensure their interaction with service users and management of behaviours is consistent and appropriate. All new staff have to complete initial training, to acquaint themselves with the home and residents and things to ensure safety. The induction training is linked to the Learning Disability Award and helps to give staff the skills and confidence to do their job properly. There are a number of training courses that staff attend following their introductory training, these are called mandatory courses and include things like, food, diet and nutrition, Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: first aid, safe moving and handling, fire safety, health and safety and infection control. Once these are completed staff have opportunities to attend other courses that are specific to caring for people with learning disabilities. Seven of the ten support workers on the staff team have attained an NVQ at level 2 or above. We talked to the manager and looked at staff files and saw that the organisation has robust recruitment procedures in place to protect residents. A number of security checks are completed before new staff start working at the home. These include written references and a criminal records check to make sure that they are trustworthy and safe to be around the residents. We also saw from staff records that they receive individual supervision with the management at least six times per year. This is to monitor performance and discuss training and development needs and achievements. Care Homes for Adults (18-65 years) Page 21 of 26 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. Residents benefit from living in a well managed home where their best interests are safeguarded and their health, safety and welfare are promoted and protected. Evidence: The manager has been in post at the home since late summer 2008 and is registered with us. This means that we think she has the right qualifications, experience and necessary skills to run the home. She is currently undertaking a leadership and management award and has, in the recent past, undertaken a course in applied behavioural analysis. This has been used to support the team to work with service users in an individualised way based on person centred support. We saw that the open management approach of the home makes sure there is good communication between staff and between service users and staff. This means that service users are consulted as far as possible and involved in the daily running of the home. They have regular house meetings and staff meetings. There is ongoing quality monitoring that includes monthly visits by a representative of the owning organization and daily and weekly quality checklists for staff and management. The AQAA indicates that they utilise review meetings, family visits and feedback on the home to assess how well they are Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: doing and identify areas for future development. Family members told us that they are constantly asked for their comments and opinions. One had recently asked for a meeting with the management and director to discuss things that were on her mind. This had been arranged without delay and she was more than happy with the outcome. Staff members spoken with said that they felt valued and that they have a voice in the home. The AQAA indicates that safety checks are up to date. The manager said that regular health and safety audits are carried out so that anything identified can be quickly remedied. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 25 of 26 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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