Care Home: 57 Pembury Road

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What the care home does well The home provides excellent care and support for the people who use this service. Their dignity is respected and equality and diversity promoted. There is a relaxed, comfortable and friendly that gives the people who use this service a homely place in which to live. The home positively promotes the health and well being of the people who use this service. this means that they can enjoy as healthy a life as possible. The people who use this service are well supported to lead busy and interesting lifestyles. this promotes their independence and gives them a wide range of choices The home manages the medicines very well. They have worked hard with health care professionals to ensure that medication is at the correct level. this has improved the health and emotional stability of the service users. What has improved since the last inspection? There have been improvements to the environment, including a new patio in the back garden. The people who use this service can now enjoy spending time outdoors when the weather is fine. More choices of activities have been added to the already wide range that the people who use this service have to choose from. The management and administration ofmedicines has improved. There is now less room for error in the ordering and administration of medicines. The home has worked hard with the people who use this service to develop end of life plans that are meaningful and reflect the wishes of the individual. A deputy manager has been appointed. This has helped to improve the organisation of documentation in the home. What the care home could do better: The way the home records the weights of the service users should be revised to show what action has been taken should there be significant, undesired weight loss or gain. The home should continue to strive for and maintain, excellence in the care and support of the people who use this service. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 57 Pembury Road 57 Pembury Road Tonbridge Kent TN9 2JB three star excellent service The quality rating for this care home is: 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: 1 5 0 1 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: 57 Pembury Road 57 Pembury Road Tonbridge Kent TN9 2JB 01732354949 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pembury.Road@theavenuestrust.co.uk The Avenues Trust Ltd Name of registered manager (if applicable) Mrs Doreen Phyllis Forward Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: 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). The maximum number of service users to be accommodated is 4. Date of last inspection A bit about the care home 57, Pembury Road is a residential home that provides care and support for up to four people with a learning disability. It is a detached house with the accommodation arranged over two floors. On the ground floor there is a lounge, kitchen diner, laundry room, shower room and one bedroom. The shower room and laundry room are accessed via the kitchen. On the first floor there is a small bathroom and separate toilet. The home has steep stairs to the first floor and is therefore unsuitable for those less ambulant or who are wheelchair users. There is a small garden and patio to the rear and parking for up to five cars to the front. 57 Pembury Road is within walking distance of Tonbridge town centre and sited on a busy main road. The fees range between £985.48 and £1008.05 per week. Additional charges are made for chiropody, toiletries, magazines and hairdressing. The Avenues Trust contributes £150 per year towards holidays and £6 per week to activities for thte service users. A copy of the last inspection report is available on request from the manager of this home. 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 How we did our inspection: This is what the inspector did when they were at the care home This visit was unannounced and formed part of the inspection process of the Commission for Social Care Inspection under the Care Standards Act. The inspection process takes into account information that we have received prior to this visit, for example, comments from relatives and visiting health and social care professionals, and information that the home has sent us, for example, notifications about significant events that may have affected the people who use this service. During the visit staff were spoken to in private to find out what it is like to work in the home. The two service users who were at home on the day of the visit were spoken to and observed to find out what they like and do not like about the home. In depth discussion was held with the registered manager, documentation, such as staff files and care plans was examined and a tour of the home was made. Both direct and indirect observation was used throughout the visit. The home was judged to provide and excellent service. Therefore the star rating for this service is now 3 Stars. What the care home does well What has got better from the last inspection There have been improvements to the environment, including a new patio in the back garden. The people who use this service can now enjoy spending time outdoors when the weather is fine. More choices of activities have been added to the already wide range that the people who use this service have to choose from. The management and administration of medicines has improved. There is now less room for error in the ordering and administration of medicines. The home has worked hard with the people who use this service to develop end of life plans that are meaningful and reflect the wishes of the individual. A deputy manager has been appointed. This has helped to improve the organisation of documentation in the home. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Wendy Mills CSCI The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 01622 724950 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Prospective service users and their supporters are given the information they need to enable them to make an informed decision about moving into the home. Appropriate pre-admission assessments were made and these continue to be reviewed regularly. This means that the home ensures it can meet the needs of the service users and that the service user will fit into the life of the home before a place is offered. Evidence: The statement of purpose and the service user guide have been recently updated. Both documents are comprehensive and contain the required information. The service user guide has been personalised for each service user. There are plenty of photographs to describe the home and descriptions are short and in Plain English. This helps the people who use this service to understand their rights and responsibilities whilst living in the home. No new service users have been admitted to the home since the last inspection. All four care plans were inspected. They all contain very detailed information about the health, care and support needs of the service users. They also describe likes and dislikes, preferred activities and cultural and religious needs. The Trust has a cultural assessment form that details equality and diversity needs. 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 people who use this service are supported to make informed decisions. This means that they can increase their independence. Evidence: The care plans are very thorough and describe every aspect of the service users lives. There is a comprehensive cultural assessment that describes equality and diversity needs. This gives a good basis for decision making. It also helps staff make decisions on behalf of the people who use the service in areas where they may not be able to make those decisions for themselves. Direct and indirect observation showed that the staff support the service users to make informed decisions. The home uses photographs to enable the people who use the service to make choices about their day to day lives such as what they would like to eat and what they want to do. Relatives and friends are encouraged to take an interest in the running of the home and to input into care plans where it is helpful for them to give information about the service users interests and preferences that they are unable to express themselves. The home has accessed advocacy services to support the service users in decision making and in other aspects of their lives. 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 supports the service users to lead busy, healthy and meaningful lives. this promotes their independence and makes their lives more interesting. Evidence: The service users lead busy lives. Each service user has a personalised activity plan that is based on their choices and preferences. They attend day centres, use the local community, some attend church and church activities. Others go out for pub lunches on a regular basis. All the service users help to choose what they want to eat and help with chores around the home. On the day of inspection it was good to see that one was helping with the washing up and another helped with clearing the tables. Care planning is person centred. This means that the service user is considered first in everything that the home does. They try to involve the service users in every aspect of the home from helping out with chores to choosing how they spend their time. The home welcomes friends and relatives and has worked hard to get back in touch with people who the service users knew in the past. The home provides transport for visits to families. The service users often have their friends round for visits. The home promotes healthy eating. on the day of inspection there was plenty of fresh produce and the fridges and freezers were well stocked. The service users are encouraged to plan what they want to eat and then help with the shopping and preparation of the food if they are able. Nutrition is carefully monitored and care is Evidence: taken to ensure that the service users maintain a healthy weight and eat a healthy diet. 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 promote the health and well being of the service users. This means that they can enjoy as a healthy a life as possible. Evidence: There is a written plan of support for each service user. These were examined in detail. Care plans are important documents. This is because they form one of the means by which the service users and their supporters can tell that they will be supported in the manner of their choice. Also, the plans are a source of reference information for the care workers who need to ensure that they assist people in a consistent and appropriate manner. The health needs of each service user are well documented in the care plans. There is good evidence that the home acts as a strong advocate to make sure health needs are met. The home has worked closely with the epilepsy nurse to get medication levels lowered. The need for less medication has greatly improved the health and well being of one service user. The home has accessed advice form Kent Association for the Blind and researched opticians to find the best advice for service users with visual problems. They have also accessed and followed speech and language therapy advice and sought professional help in helping the service users make decisions about dental treatment. Records show that all necessary specialist appointments are made and kept. In addition, the home makes good use of the local general medical practice. The service users attend chiropody and district nurse appointments and have regular health checks. The systems for the management and administration of medication has been reviewed and a new pharmacy supplier sought. The home has changed from using the Nomad system to a monitored dose system for medication. Storage, ordering and returns Evidence: systems and Medicines Administration Records (MAR) were examined. All were found to be in good order. All staff administering medicines have received training and there are regular checks made on medication. The home has helped service users who have suffered bereavement to understand the way they feel and to help them with their grief. Each service user now has a document that they have helped complete that describes what they want to happen when they die. They have been supported to talked about sensitive issues such as funeral arrangements and to choose the hymns that they would like to have played. The home has handled this very well indeed and has really helped the service users to talk about their wishes in their own way. The home and the service users are commended for the work they have put into dealing with end of life issues. 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 robust policies and procedures for handling concerns, complaints and safeguarding that are clearly understood by staff. This means that the home does all it can to listen to the worries of the service users and to protect them from harm. Evidence: The home has robust policies and procedures in place for handling complaints, concerns and safeguarding. Conversation with staff showed that they know how to deal with complaints and safeguarding issues. They have received training in the protection of vulnerable adults and said that they would have no hesitation in reporting concerns to the manager. The area manager makes regular visits to the home and talks to the service users and staff to make sure there are no worries. 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 . The environment is clean, well maintained and homely. It meets the current needs of the people who use this service and gives them a pleasant and relaxed place in which to enjoy their lives. Evidence: The home is well maintained and homely. It was clean and hygienic on the day of inspection. There have been recent improvements to the environment, including redecoration of some communal rooms and a new kitchen. Outside the garden has been cleared and a pleasant patio area created. One service user was proud to show us his room. He said that he likes spend time in his room and that he has lots of things there to keep him busy. He said that he likes to sort things out in his room himself and enjoys doing this. Staff said that the home has a real family atmosphere and that they believe all the service users understand that this is their home and are relaxed and happy living there. The home meets the needs of the people who live there. Although there are one or two areas that are not ideal, for example, the stairs are quite steep and the upstairs bathroom is rather small, observation showed that the service users are relaxed and happy in their home. They can all still access all areas of the home with ease. Conversation with the area manager for the Avenues Trust and the registered manager showed that they are well aware of the effects of aging and are keeping a close watch to make sure that the environment still suits the service users as they become older. 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 meet the needs of the people who use this service. Staff training and staff recruitment practices are excellent. There is a stable staff team who work well together and morale is good. This means that the service users are supported by a well qualified, cheerful and committed staff team Evidence: Two members of staff were interviewed in private. They spoke very positively about the home and the way it is managed. One said, The manager is very straight with us and has made some good changes. Another commented, Our manager is very positive, approachable and a force for the good. Staff say that they enjoy working in the home and that there is a stable staff team and good team working. The Avenues Trust has its own training organisation called, The Avenues Academy. The Trust keeps a close watch on training and the deputy manager of the home has recently improved the documentation that records staff training undertaken and training needs. Staff are positively supported and encouraged to work towards the National Vocational Qualifications (NVQs). All staff have an annual competency review to make sure that they are undertaking the necessary taring and putting this into practice. Staff are well supervised and there is good communication within the home and with the Trust. There are regular one-to-one supervision sessions and staff meetings. Staff confirm that communication is good. They said that they are offered plenty of training and are helped to develop and grow with the job. Staff are clear about their roles, responsibilities and reporting mechanisms whilst working in the home. There is a good mix of age groups, personalities, gender and backgrounds amongst the staff. This means that there are lots of different skills amongst the staff. This helps Evidence: to promote equality and diversity and makes the lives of the people who use this service much more interesting. Records confirm that there is plenty of staff training. The main staff records are kept at the head office but there is a tracer in the home that shows appropriate preemployment checks have been made, including Criminal Record Bureau (CRB) checks and written references. The registered manager described the thorough recruitment process. This includes careful checks on previous employment history, an in depth interview and a probationary period. Staff said that they work well together and that there is a good atmosphere in the home. 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. The views of the service users and their supporters are listened to and acted upon. This means that the home is run in the best interests of the people who use this service. Evidence: Time was spent in conversation with the registered manager. It is clear that she understands the principles of best practice in care and that she has an excellent knowledge of the service and the needs of the people who use this service. She has been working at the home for ten years and holds National Vocational Qualification (NVQ) in Care at levels three and four. She also has the Registered Managers Award (RMA) and a Diploma in Management. She spoke of additional training that she undertakes and there is good evidence that she keeps up to date with training. Staff spoke highly of the registered manager. They said she is, Firm but fair, and that she is prepared to tackle difficult issues when necessary. They said that she is works hard on behalf of the service users and that she seeks out best options for them. Indirect observation showed that the registered manager has a good professional, working relationship with staff. The service users are relaxed and comfortable in her company. Since the last inspection a deputy manager has been appointed and this has helped a lot in getting staff training records updated and paperwork more organised. Evidence: The Avenues Trust is a not-for-profit organisation that keeps up to date with best practice. An area manager visits the home on a regular basis and the registered manager said that this is a great support as it means there is always someone she can discuss ideas and concerns with. The manager was able to put her hand to all paperwork requested during this visit and she appeared competent and well organised. There are sound quality assurance systems in place. The homes Annual Quality Assurance Assessment (AQAA) that is required by the CSCI was comprehensive and informative. It gave good evidence that the home does its best to seek the opinions of the service users and their supporters. There are annual stakeholder surveys, informal discussions with relatives and observations made and recorded when service users express preferences. There are clear policies, procedures and guidelines for health and safety in the home. Regular health and safety checks. such as infection control and fire safety, are made and recorded. In addition, the area manager makes visits in accordance at least once a month, but often more frequently to oversee these checks and to talk to staff and service users. No health and safety hazards were noted on the day of this visit. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) 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. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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