Care Home: 95 Ashley Avenue

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What the care home does well The house is run like a family home.The people living in the home are assessed regularly to make sure the service is meeting their needs.People are supported to have an active lifestyle. They are encouraged and supported to do as much as possible for themselves.People are supported with their communication and challenging behaviour to increase the opportunities available to them. People are also helped by other professionals in the community like the community learning disability nurse and occupational therapist.The home meets the physicaland healthcare needs of the people who live there. There is input from specialists and local GPs. There is a good range of training including person centred planning and managing challenging and potentially destructive behaviour with positive behaviour support. People are protected well by the homes policies and staff training in safeguarding. What has improved since the last inspection? Each person has a person centred plan or is making one. This has information about what is important to them and how they would like to be supported.People have continued to try different activities.A handrail has been fitted in the home to help people get around.They have bought a new car that is easier to get in and out of.They have some new furniture and carpets.The shower room has been completely redecorated.The outside of the house has been painted and decorated. What the care home could do better: The manager is making sure that everyone gets a say about the home and is always looking for ways to make the service better. Key inspection report Care homes for adults (18-65 years) Name: Address: 95 Ashley Avenue 95 Ashley Avenue Folkestone Kent CT19 4PJ 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: Julie Sumner Date: 0 7 0 4 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: 95 Ashley Avenue 95 Ashley Avenue Folkestone Kent CT19 4PJ 01303266453 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Sharyn Deidre Buss Name of registered manager (if applicable) Mrs Sharyn Deidre Buss Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home 95 Ashley Avenue is a town house in Cheriton. It is near local shops and other places like the church, library and pubs. Three people with a learning disability live there. Each person has their own bedroom. Two bedrooms are on the ground floor. Care Homes for Adults (18-65 years) Page 5 of 34 The provider will tell you how much it costs to live there. 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: 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 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 The manager sent us an annual quality assurance assessment (AQAA) which tells us about the service provided, what improvements have been made and how they plan to develop it further. The AQAA was very clearly written and gave us all the information we needed to plan the inspection visit. We sent 3 surveys out to the people living in the home and 10 to the different people who are involved with them. We received 9 surveys back. Care Homes for Adults (18-65 years) Page 8 of 34 We visited the home at 8.30 in the morning and stayed there until 1.30 in the afternoon. We talked to all the people living in the home before they went out. We talked to the manager and the staff who were working that day. We had a look around in the house and outside. We looked at some of the policies and procedures. Care Homes for Adults (18-65 years) Page 9 of 34 We looked at plans and records for supporting the people living in the home. We also looked at staff records like what checks have been made before they started work and training they have been given. What the care home does well The house is run like a family home. Care Homes for Adults (18-65 years) Page 10 of 34 The people living in the home are assessed regularly to make sure the service is meeting their needs. People are supported to have an active lifestyle. They are encouraged and supported to do as much as possible for themselves. People are supported with their communication and challenging behaviour to increase the opportunities available to them. People are also helped by other professionals in the community like the community learning disability nurse and occupational therapist. The home meets the physical Care Homes for Adults (18-65 years) Page 11 of 34 and healthcare needs of the people who live there. There is input from specialists and local GPs. There is a good range of training including person centred planning and managing challenging and potentially destructive behaviour with positive behaviour support. People are protected well by the homes policies and staff training in safeguarding. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 12 of 34 Each person has a person centred plan or is making one. This has information about what is important to them and how they would like to be supported. People have continued to try different activities. A handrail has been fitted in the home to help people get around. They have bought a new car that is easier to get in and out of. Care Homes for Adults (18-65 years) Page 13 of 34 They have some new furniture and carpets. The shower room has been completely redecorated. The outside of the house has been painted and decorated. What the care home could do better Care Homes for Adults (18-65 years) Page 14 of 34 The manager is making sure that everyone gets a say about the home and is always looking for ways to make the service 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 Julie Sumner CQC South East, Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA Telephone 03000 616161 Care Homes for Adults (18-65 years) Page 15 of 34 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 16 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 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed to make sure the home can support them well. Evidence: The home has a clear statement of purpose and service user guide. No one has moved in or out of the home since our last key inspection. We spent some time with the people living there and they told us they like it and we saw from their behaviour that they are settled. Each person had an assessment of their needs and likes when they moved in and these are updated as needs changed and as part of their review of support. The assessment process is thorough and involves other professionals like a community learning disability nurse and community occupational therapist. Care Homes for Adults (18-65 years) Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service recognises the right of individuals to make their own decisions and support people in a positive way. People are helped to stay safe carrying out their day to day activities. Evidence: We looked at one of the support plans in detail and at parts of another. We saw that they contain clear information for the staff to support each person in the way that they need. We saw that people are being supported to create another part of the plan, a person centred plan, which has pictures and shows clearly who and what is important to the person. One person really likes to show other people his All about Me book and we had a look at it and could see that this gave a good idea of what they person likes and how he likes to be supported. Risk assessments were in the care plans. There are clear guidelines for staff to minimise risk and include assessments for activities inside the home like having a bath and baking and for activities outside like going into town. This is so that if people want to do something they are not stopped because it is thought to be unsafe. Instead staff work out Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: what support is needed to make it as safe as possible. We discussed with the manager and staff how people are enabled to make choices and express themselves, particularly when they have verbal difficulties. Everyone who has needed assistance has had support from the community speech and language therapist. Support has also been provided to individuals from the psychologist as some of their behaviour is a means of communication. The house is run as a family home rather than as a house in which three individuals live. The manager and staff have general discussions on a day to day basis. They have also one to one meetings with individuals to give them the opportunity to say what they think. Peoples views are then taken into account when making decisions around the home. The manager said that if an individual needed to make a life changing decision they would be supported with best interest meetings in line with the Mental Capacity Act 2005. Each person has an advocate and the support of family and care managers. We could see that people are supported well to make choices and to communicate with other people. Care Homes for Adults (18-65 years) Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are involved in meaningful daytime activities of their own choice and participate in the day to day running of the home. Evidence: There are a variety of activities on offer to the people living in the home. Everyone was going out to the resource centre on the day we visited and we spoke to them before they went out. They said they like shopping and going to the pub. They also said they like reflexology and massage and showed us their life plan book which had photos of them participating in some of these activities. The manager said that they like grocery shopping and clothes shopping, of which they take an active role, and also have fun just looking. There are always 2 staff to take people out. The home has a people carrier vehicle to take people out for appointments, outings and shopping. People go out in the local community and the manager said they are well known and Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: have good relationships with local shopkeepers and neighbours. They also go on holiday each year and have been away recently. They collected leaflets and days out and events were planned in advance. They told us they like going on holiday and showed us some photos. Visitors and families are actively encouraged to maintain relationships with the people living in the home. People are supported to maintain contact by phone and visits and they talked to us about that also. We saw in the records and from talking that people are supported with bereavement of people close to them. The home is run like a family home and there are no restrictions. People can access all parts of the home except each others bedrooms where privacy is respected. The general routines in the home are flexible. People have timetables in their rooms so that they know what is happening at different times of the day. They plan this at the beginning of the week. There is a four-week menu plan based on the known likes and dislikes of the people living in the home. There is a menu board with laminated pictures that each individual can choose from. Mealtimes are organised around everyones activities and the menu is flexible. The kitchen is open plan and people can participate in the meal preparation and other activities like baking. Care Homes for Adults (18-65 years) Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care support is responsive to the varied and individual needs and preferences of the people who live in the home. Evidence: Each person has guidelines written in their person centred plan that explain what is important to them and how they would like to be supported. This includes support with their personal care and their general day to day routine. The manager and staff have found out what people want by getting to know them and talking to them. Each person has a health action plan. These are contained in the support plan folders. They are kept up to date with any changes and contain clear information to assist staff to support the person with their health care. We could see that people are getting support from community health care services for specific medical conditions and as required. One persons health needs changed recently so they saw the neurologist, anothers mobility needs have changed so the physiotherapist and occupational therapist have been involved. The parts of the plan referring to health in the All about Me book have pictures and photos. The people living in the home are supported by the staff to take their medication. We looked at medication storage and records. The manager explained that they are making Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: sure that everyone taking medication is assessed by the medical services so that they can reduce it as much as possible. Where people have come into the home with high levels of medication because of their challenging behaviour they have been able to reduce it. This is because they can support the person and manage the behaviour using positive active support and listen to what they are trying to say, instead of medication to calm them. Care Homes for Adults (18-65 years) Page 24 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. The people living in the home are supported to voice their concerns and the procedures in the home protect people from abuse. Evidence: The manager has produced a service user friendly complaints procedure. The manager said that she and the staff hold one-to-one meetings with the people to give them an opportunity to express their views. We saw that the people living in the home were listened to and staff were responsive to them. Each person also has someone who will advocate for them. There have been no complaints about the service provided. The manager has a safeguarding policy and has made sure that staff are fully aware of their responsibilities. We talked to the staff and they confirmed that they have attended safeguarding training and were confident about how to respond if they suspected or witnessed abuse. We could see that staff have a good range of training to support people to say what they want and staff know what to do if there is an incident. The service is active in making sure that if there is an incident that they think may need reporting that they contact us and firstly the local social services safeguarding team. 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 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 clean and comfortable and suitable for the needs of the people living there. Evidence: One of the people showed us around the home explaining where everything was. The home looked well decorated and the person told us it was warm and comfortable and they like it. Parts of the home have been newly decorated like the shower room also with new flooring and there is new carpet in the hallway and dining room. They have also bought new dining room chairs to assist with one of the peoples mobility change. He also showed us the new hand rail that has been installed to help him. He was very pleased with this. People have their bedrooms decorated how they want and have lots of belongings depending on what they are interested in. The laundry is appropriate for the needs of the house. Staff have received training in health and safety and infection control. They have a designated health and safety officer who has completed an extensive training programme. There is a small back garden that has been planted into pots to grow a variety of plants including flowers, tomatoes and strawberries. Care Homes for Adults (18-65 years) Page 26 of 34 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. The service has plentiful staff available at all times to support the needs, activities and aspirations of the people using the service in an individualised and person centred way. Evidence: The manager has a thorough recruitment process to make sure the people applying for the job are who they say they are and will work in the right manner. She asks for identification like a passport and 2 references from people who know the person including their previous employer. She requests a Criminal records bureau (CRB) check and independent safeguarding adults first (ISA) check to make sure they have not done anything in the past that will indicate that they are unsuitable or cannot be trusted. Staff work for a trial period of time in the home while everyone gets to know each other. We looked at two staff files with the manager and saw that all these checks had been carried out. The manager explained that the staff team is very stable and staff do not leave very often. They recently needed to recruit a member of staff and it took a long time to find the right person. The manager said she involves the people living in the home in choosing who they like. The new member of staff has settled in well. We talked to the manager about the staffing level. We could see that there were enough staff to support the individually assessed needs of the people living in the home. We could see that people can go out when they want and do different things. They also go out in the evenings and Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: weekends. Each person has induction trainng when they start and we had a look at the training package the manager is designed. This is in line with the SKills for Care training. We talked about staff training with the manager and the staff. They told us that they regularly attend training that they need to do to comply with the law like health and safety training. They also told us that they have training for their specific job roles and to support the individual needs of the people living in the home. Training is undertaken both in house and at local colleges. The staff have received training in person centred planning, epilepsy, Mental Capacity Act 2008 and in managing behaviour. The staff are supported to achieved national vocational qualification and one of the staff is studying this to level 4. Staff spoke enthusiastically about their roles and we saw that they behaved in a calm and confident manner and were respectful and positive when talking to the people living in the home. The manager holds one-to-one meetings with the staff and each person will have an annual appraisal. These meetings and the appraisal give them the opportunity to discuss any issues and to consider their knowledge and skill development. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has a clear understanding of the key principles and focus of the service. She has good people skills and understands the importance of person centred care and effective outcomes for the people living in the home. Evidence: The registered owner and manager, Sharyn Buss, has many years of experience in supporting people with learning disabilities and has achieved the national vocational qualification to level 4 and has the registered managers award. She runs the home as a family home. There is a quality monitoring process in the home. Questionnaires are sent out to all people who are involved with the home. They also have meetings with the people living in the home to find out what they think about the home and if there is anything different they want to do. This feedback is used by the manager to plan improvements to the service provided. The staff have attended fire training and other training required by law for health, safety and wellbeing. The water temperatures are checked to make sure it is a safe temperature Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: before a person has a bath or shower. The home has regular servicing for its heating, water and equipment. All substances hazardous to health are kept locked away. The manager and staff know who to and when they need to report incidents and accidents. 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 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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