Care Home: 62 Second Avenue

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What the care home does well If anyone new wanted to come to the home they would be assessed to see if their needs could be met, and that they fit in with the people already living there. The help and support people need is written in a care planPeople are helped to make choices for themselves and examples of these were seen in some residents meeting minutes.There are books with signs and pictures in to help people make choices.Staff make sure people can do things for themselves without getting hurt. One person was seen making himself a hot drink.People are able to go to a local day centre and one person said, "I`ve been to conservation, I got a new T shirt". People are able to do things out of the home. One person goes to watch Nottingham Forest football matches and everyone goes to the cinema. People are known in the local pub when they go for a drink.One person said she had been to see her mum when she was poorly and staff support people to spend time with their families.People are able to plan and help make their meals, sometimes they eat out or have a take away. One person said, "take away" and showed a menu for a Chinese take away People receive the healthcare they need. One person nodded when asked if he had received treatment on his ears. Another person said, "I have been to the doctors about my eyes". People can raise complaints and action is taken to ensure people are safeguardedOnly staff who have been checked to make sure they are the right sort of people to help others come to work in he home.The home is well run, and people can say what they think about living there What has improved since the last inspection? Some improvements have been made to how people are given their medication.The inside of the home is going to be changed to make it better for people living there What the care home could do better: The file kept about what healthcare people need should be kept more up to date Key inspection report Care homes for adults (18-65 years) Name: Address: 62 Second Avenue 62 Second Avenue Carlton Nottingham NG4 1GS The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Stephen Benson Date: 0 9 0 6 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 Care Homes for Adults (18-65 years) Page 2 of 34 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 34 Information about the care home Name of care home: Address: 62 Second Avenue 62 Second Avenue Carlton Nottingham NG4 1GS 01158443707 01159104267 kelly.moloney@ncha.org.uk www.ncha.org.uk NCHA 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 Over 65 4 0 learning disability Additional conditions: Service Users shall be within Category LD Date of last inspection 2 3 1 0 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home 62 Second Avenue is a home where up to four adults with a learning disability live. The home is in Carlton, where there are shops, pubs and other places for people to go, including a doctors surgery. You can catch a bus from the main road into town. There is room to park 3 cars at the front of the house and there is a back garden for people to use. All of the bedrooms are on the first floor and as there is not a lift it is unsuitable for people with mobility problems. Care Homes for Adults (18-65 years) Page 5 of 34 A service user guide and a copy of the most recent inspection report are available from the home. The fees for the home range from £331.88 to £367.20 per week. Care Homes for Adults (18-65 years) Page 6 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 34 How we did our inspection: This is what the inspector did when they were at the care home We visited the home in June 2009 and we met the deputy manager, staff and people who use the service. We asked the deputy manager and staff about what they do for people We looked at peoples records. We wanted to see what information it had and where it came from. We wanted to see if people are happy with their service. We also looked at staff files to see if they are safe to work with people. We looked at other paperwork and information the service has sent to us. Care Homes for Adults (18-65 years) Page 8 of 34 What the care home does well If anyone new wanted to come to the home they would be assessed to see if their needs could be met, and that they fit in with the people already living there. The help and support people need is written in a care plan People are helped to make choices for themselves and examples of these were seen in some residents meeting minutes. Care Homes for Adults (18-65 years) Page 9 of 34 There are books with signs and pictures in to help people make choices. Staff make sure people can do things for themselves without getting hurt. One person was seen making himself a hot drink. People are able to go to a local day centre and one person said, Ive been to conservation, I got a new T shirt. People are able to do things out of the home. One person goes to watch Nottingham Forest football matches and everyone goes to the cinema. People are known in the local pub when they go for a drink. Care Homes for Adults (18-65 years) Page 10 of 34 One person said she had been to see her mum when she was poorly and staff support people to spend time with their families. People are able to plan and help make their meals, sometimes they eat out or have a take away. One person said, take away and showed a menu for a Chinese take away People receive the healthcare they need. One person nodded when asked if he had received treatment on his ears. Another person said, I have been to the doctors about my eyes. People can raise complaints and action is taken to ensure people are safeguarded Care Homes for Adults (18-65 years) Page 11 of 34 Only staff who have been checked to make sure they are the right sort of people to help others come to work in he home. The home is well run, and people can say what they think about living there What has got better from the last inspection Some improvements have been made to how people are given their medication. Care Homes for Adults (18-65 years) Page 12 of 34 The inside of the home is going to be changed to make it better for people living there 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 Care Homes for Adults (18-65 years) Page 13 of 34 If you want to speak to the inspector please contact Stephen Benson CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 14 of 34 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 15 of 34 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. Anyone new coming to the home would be assessed to ensure their needs could be met and they were compatible with others living in the home. Evidence: The home provides long term placements to people living there, as a result there are few occasions when anyone new is planned to move to the home. The deputy manager said there is a referral process when there is a vacancy and only people who meet the set criteria would be considered, which includes how they would fit in with other service users. The care files for each person living in the home, were seen and each of these had an assessment in. In the Have your say about 62 Second Avenue surveys returned three people answered answered yes to the question, were you asked if you wanted to move into this home? and one person did not answer. Page 16 of 34 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 17 of 34 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 needs and individual goals are reflected in their care plans, and they are supported to make the decisions they are able to, as well as risks as part of an independent lifestyle. Evidence: Care plans and risk assessments are prepared using a computer based programme and then printed and placed into a care file. Plans have recently been transfered to a new programme, and it was noted that some could not be located, although there were paper ones in the care file. The deputy manager said they would be going through them all to ensure they have all moved across. The deputy manager said they were going to introduce a one page precis of each persons plans for staff to refer to. A sample of care plans were checked to see if they reflected the support provided, and were found to do so. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: Each persons care files were seen and the majority of these were clear and described the support needed, although one plan was not as clear as the others. All plans were kept under review and a reminder is generated when they are due to be reviewed. There were Mental Capacity Act Assessments seen on three files and staff said the fourth one will be completed shortly. Staff were seen encouraging people to make decisions about what they want to do. One person was taken to a travel agent to choose a holiday and others have already selected one on line. There were references seen in residents meeting minutes to people being given and making choices, for example references were made to choosing decor and furnishings for the home in the forthcoming refurbishment. There were communication aids seen around the home to help people make choices and decisions. Staff were seen using a picture book with one person to help him make choices. Staff described how their knowledge of people helps the support them to make decisions. People are able to take part in a variety of activities following a risk assessment to establish what safeguards are needed to enable them to do so. These include fairground rides and swimming. Risk assessments are also completed over daily activities such as cooking and using knives. One person was seen making himself a hot drink in the kitchen. Care Homes for Adults (18-65 years) Page 19 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to take part in appropriate activities and maintain family relationships. Their rights are respected and they enjoy a variety of meals. Evidence: Each person living in the home attends one of the local day centres either four or five days a week. Staff were seen supporting people to catch the bus to take them there and then meet them when they returned. One person said when she came back, Ive been to conservation, I got a T shirt. Care files showed that service users use community based resources. One service user has a Nottingham Forest season ticket and another goes to a weekly dance group. Last weekend some service users went to the cinema and went for a walk to a local supermarket. The previous weekend there had been an outing to a local music festival. Staff said service users are known in the local pub where they go for a drink and speak Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: with the neighbours. It was stated on the Annual Quality Assurance Assessment that, As a result of working with families around dealing with service user behaviours that might challenge, it has been noted that family activity has been more productive and enjoyable. The deputy manager said there are close working relationships with families. Staff spoke of families phoning and visiting on a regular basis. Where possible some service users have overnight stays with their families. One service user who was case tracked said, My mum has been poorly, I went to see her. People were seen looking at photograph albums which included holiday pictures and family gatherings. The deputy manager said the daily routines in the week work around service users attendance at day centres. Although service users can choose their routines, they tend to prefer a fixed routine. In the Have your say about 62 Second Avenue surveys returned two people answered answered yes to the question, can you do what you want to do during the day, evening and at the weekend? and two people did not answer. One service user was seen tidying up some magazines and papers which staff said he always does. Another service user was seen turning on some music and another sat in the garden with a member of staff. There are different meal arrangements depending on the preferences and abilities of each service user. One person helps herself to cereals for breakfast whereas another needs this to be done for him. A menu plan is prepared each week in a residents meeting. This is used as a guide and can be changed if wanted. A service user said, We choose the menu, we have spaghetti bolognaise tonight. One service user said, take away and went and got a menu for a Chinese take away. Staff said service users take it in turns to go shopping for food and they have had a barbecue in recent good weather and sometimes they go out for a pub meal or collect a take away. Care Homes for Adults (18-65 years) Page 21 of 34 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. Service users have the level of personal support they require but their healthcare needs are not being as closely monitored as they could be. Evidence: People had differing levels of support they need described in their care files and staff were aware of the different levels of support needed by different service users. There were symbols seen around the home to use as prompts. Daily notes showed that service users have regular baths. It was stated on the Annual Quality Assurance Assessment that, All service users have got health care action plans and health care MOT has been used to update all support plans. Generally the health care action plans were not fully completed or up to date. One plan said the service user needed daily exercises on her tendons. Staff said this was a bit hit and miss when this was done and some staff have not been trained up to do this. The recording chart showing when this was done had not been filled in. There was also a weight monitoring chart seen not being completed as required. A member of staff was heard asking a service user if he had received some treatment on Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: his ears to which he indicated he had. A service user said, I have been to the doctors about my eyes. It was stated on the Annual Quality Assurance Assessment that staff receive annual medication training from the pharmacist, and the storage and recording systems were properly maintained. Care Homes for Adults (18-65 years) Page 23 of 34 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. There is a system in place to raise any complaints and action is taken to safeguard service users. Evidence: It was stated on the Annual Quality Assurance Assessment that, We have a clear complaints procedure which can be made available in different formats. It was also stated that there have not been any complaints made, but there have been two safeguarding investigations. These investigations have been concerning behaviour towards one service user from another. One has been completed and the outcome is requires no further action and the other is still ongoing. The deputy manager is attending a meeting later in the week about this. It was also stated on the Annual Quality Assurance Assessment that, .....the staff team have become very skilled in dealing with such challenges, and using de escalation techniques to calm situations. In the Have your say about 62 Second Avenue surveys returned two people answered always to the question Do the staff treat you well? and two people did not answer. The deputy manager said a praise and grumble system has just been introduced to manage any smaller complaints or praises made about the service. Staff were aware of the complaints procedure and have had training on safeguarding Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: adults. Staff were also aware of the whistleblowing policy. Care Homes for Adults (18-65 years) Page 25 of 34 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. Service users will live in a more comfortable building, which is better suited to their needs, when the refurbishment is carried out. Evidence: It was stated on the Annual Quality Assurance Assessment that, Given the psychical damage the home is subjected to on a regular basis it is a homely welcoming environment (as stated in previous assessments and by visitors) our home is clean and tidy and generally well maintained. There are a number of limitations that have been identified with the building and a major refurbishment is planned in the next few weeks whilst service users are on holiday. There are plans to keep them informed through photographs of the changes whilst away, to lessen any surprise on their return. The deputy manager said there has been uncertainty over the future of the building which had held back some developments, however now work was to be done this would bring in a range of improvements. Service users are supported to carry out some of the routine domestic tasks needed to keep the building clean and tidy. There is protective clothing available and there is a sluice facility on the washing machine. Staff have had training on infection control. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: In the Have your say about 62 Second Avenue surveys returned one person answered always to the question Is the home fresh and clean? and two people did not answer. Care Homes for Adults (18-65 years) Page 27 of 34 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. Service users are supported by competent and qualified staff, and protected by the recruitment policy and practices. Peoples individual and joint needs are met by appropriately trained staff. Evidence: Staffing levels are varied according to the number and needs of service users at the service, and staff said there were always sufficient staff on duty to meet their needs. In the Have your say about 62 Second Avenue surveys returned two people answered always to the question Do carers listen and act upon what you say? and two people did not answer. There is an arrangement agreed with us that staff files are held centrally by Nottingham Community Housing Association provided they are open to inspection when required, however they were not seen on this occasion. The deputy manager said all the required pre employment checks are carried out and a recently appointed member of staff said she had provided references and had undergone a Criminal Records Bureau check. There is a training record of the training staff have undergone and when they are due for Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: refresher training. It was stated on the Annual Quality Assurance Assessment that nine of the twelve staff have successfully completed National Vocational Qualification level 2 or above. Staff said they thought the training provided was good and they felt supported in carrying out their duties. Care Homes for Adults (18-65 years) Page 29 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable management arrangements in the home to ensure the home is run in the best interests of people living there. Evidence: The manager was on leave when this visit was carried out. It was stated on the Annual Quality Assurance Assessment that the manager has completed the Registered Managers Award and is due to complete the National Vocational qualification level 4. Staff said they thought the home was well run in the best interest of service users. There was information about The Quality Tree (a quality assurance tool supported by the Local Authority) in the office and the deputy manager said staff use this when working with service users in one to one time. It was stated on the Annual Quality Assurance Assessment that there is, Regular supervision of the staff team to maintain quality and promote growth and development. The deputy manager said that all the required health and safety checks are carried out at Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: the required frequency and there are service contracts in place for servicing all the equipment. Dates of tests were recorded on the Annual Quality Assurance Assessment showing they are regularly carried out. Care Homes for Adults (18-65 years) Page 31 of 34 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 Care Homes for Adults (18-65 years) Page 32 of 34 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 1 19 13 Ensure all health care action 01/08/2009 plans are kept up to date and followed. This will make sure service users healthcare needs are being met 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 33 of 34 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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