Care Home: Ahava

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What the care home does well Provides a good standard of individualised care for service users. The service with the support of the organisation is now committed to achieving positive outcomes for service users. Provides a safe and homely environment for service users. Benefits from a core of competent and committed staff that ensures consistency of care for service users. What has improved since the last inspection? The consistency of approach to service users is improving across the staff team. There was evidence that overall outcomes for service users had improved and was continuing to improve. The overall cleanliness of the home and health and safety procedures has improved. Documentation has been brought up to date and is now in line with the organisations guidelines. What the care home could do better: Ensure that management arrangements include the appointment of a permanent appropriately qualified manager without undue delay. Ensure that documentation is maintained to a satisfactory level and supports the work with service users. Replace the current kitchen as part of ongoing refurbishment. Ensure standards of cleanliness and health and safety are maintained for the benefit of service users. Key inspection report Care homes for adults (18-65 years) Name: Address: Ahava Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ     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: Sally Newman     Date: 2 9 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 26 Information about the care home Name of care home: Address: Ahava Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ 01344755592 test Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): bucketsandspades@norwood.org.uk Norwood Ravenswood Ltd T/A Norwood The registered provider is responsible for running the service care home 10 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Ahava is one of 16 homes for adults with learning difficulties located at Ravenswood Village, and owned and run by Norwood Ravenswood Village. Ravenswood Village provides a culturally appropriate environment for Jewish individuals, and accepts nonJewish individuals who are happy to be part of a Jewish service. The Village is set in 125 acres of Berkshire countryside, and a wide range of activities is provided. Care Homes for Adults (18-65 years) Page 4 of 26 10 Over 65 10 Brief description of the care home Ahava provides accommodation for ten people in six self-contained flats. There is a staff office based in one of the flats. The accommodation and staff deployment supports the semi-independent living arrangements for the men who live there, and are the responsibility of the registered manager. The fees range from £38,310.03 to £54,285.53 per annum. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that was conducted over the course of three days and included a visit to the service of five hours duration. A tour of the premises was undertaken and limited time was spent observing practise in the service and talking to staff and senior managers who arrived for feedback about the inspection. A range of documentation was seen and the A grade from the service provided assistance with clarifying evidence and planned activity. There was evidence that the outcomes for all service users have improved since the last random inspection visit to the home conducted on 25th May 2010. Information held about the service by the Commission and evidence gathered during the course of the visit has been used in the formulation of this report. All outcome areas were good with the exception of conduct and management of the home which was considered to be adequate. No requirements or recommendations were made as a result of this inspection. The provider has a range of policies and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service is able to provide a service that meets the needs Care Homes for Adults (18-65 years) Page 6 of 26 of individuals of various religious, racial or cultural needs. No complaints have been received about this service by the Commission since the last key inspection. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience 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 can be confident that their needs will be appropriately assessed to ensure that the service can meet their needs before a place is offered. Evidence: The records for one service user who moved into the home earlier this year were seen. A transition plan had been drawn up that focused on this individuals needs in relation to a move to the home. This individual has now settled well. The organisation has a range of policies and procedures regarding moving new service users into the home that provides guidance and expectations for staff. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Plans of care provide relevant and comprehensive information about individual service users needs and enables staff to provide support and guidance according to personal preferences. Decision making is supported and encouraged by the service and risks to individuals are assessed and documented. Evidence: Considerable work has been undertaken to bring all plans of care up to date and in line with the organisations policies and procedures. Two plans of care were picked at random and reviewed. All relevant and current information was accessible and had been recently reviewed by staff from the home. In discussion with staff it was apparent that service users particularly those from the ground floor area are encouraged and supported to make choices about their everyday lives and the service was working on ways to demonstrate this more effectively within documentation. Risk assessments were in evidence and had been subject to recent review. These were individually focused. Risks associated with the home must be assessed and reflected Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: within those individuals plans of care who may be effected. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users take part in valued occupational and leisure activities with their peer group and within the local community. They are supported with appropriate relationships and to maintain links with family and friends. Service users are enabled to choose from a healthy diet. Evidence: Service users are encouraged and supported to lead fulfilling lives appropriate to their needs, wishes and preferences. Each service user has a full programme of activities including a wide range of leisure pursuits, computing, gardening, music, sports, and art sessions, shopping and restaurant trips and employment opportunities. Activities are also conducted within the home. Community access is supported and encouraged and evidence seen within care plans confirmed that service users access the doctors, dentist and hospital appointments where appropriate. Service users meetings are now being held regularly and staff Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: support and encourage their participation in these events. All service users have a holiday according to their individual needs and preferences. This may take the form of day trips if this is more suited to the needs of the individual. Each service user key file contains details of family, friends and advocates. The home actively encourages contact with family, although for most service users contact has been limited for a variety of reasons. It was evident from discussion with staff that the philosophy of the home promotes the rights of the service users and recognises their responsibilities. Where able service users are supported and encouraged to participate in daily living tasks such as laundry and cleaning. One service user proudly showed me the shower he had recently cleaned. The arrangements for the provision of food are overseen by the staff team as a whole. Service users are now being encouraged to become involved more in menu choices appropriate to their needs. Alternatives chosen each day are recorded. Indirect observation conducted during the course of the lunch confirmed that the atmosphere was relaxed, unhurried and staff encouraged and supported service users to make choices. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support in the way they prefer and their physical and emotional health care needs are met. Service users are protected by the homes policies and procedures on dealing with medicines. Evidence: The plans of care seen provided comprehensive information about the personal and health care needs of individual service users. Preferences in relation to personal care was recorded and enabled staff to undertake tasks with individual service users that focused upon their needs and was designed to reduce potential anxiety and frustration. Daily routines are flexible and bedtimes and mealtimes are not rigidly enforced but take account of individual timetables. Health Action Plans are in place for service users and are designed to ensure that a range of health checks relevant to the individual are undertaken on a regular basis. From the two seen some updating of information is required. The arrangements for medication have been subject to a complete review and now adhere to the organisations policies and procedures. There are no service users who currently administer their own medication. All staff who administers medication have received appropriate training with regular refresher training being provided. The Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: medication prescribed for individual service users is reviewed regularly as needs change and at least on an annual basis Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have their views listened to and are protected from abuse, neglect and self-harm. Evidence: There is a robust and comprehensive complaints procedure in place that is provided by the organisation. Information provided by the service prior to the visit confirmed that no complaints had been received by the service since the last inspection. No complaints or concerns about this service have been received by the Commission. There were posters in evidence in the upstairs corridor that gave clear instructions for service users on what they should do if they had concerns. All staff have received training in safeguarding adults although some refresher training needs to be undertaken by some staff and this has been addressed and courses have been booked. Two safeguarding referrals had been made to the local authority since the last inspection at the request of the Practice Development Manager. In both situations the local authority did not consider that the two incidents met their criteria for referral and the home conducted its own investigations. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users now benefit from a homely, safe and comfortable environment that is maintained in a clean and hygienic condition. Evidence: A tour of the premises was undertaken. Considerable effort has been put into cleaning and organising the service so that it meets minimum standards of cleanliness. There are now cleaning rotas in place that are overseen by management personnel. The home is appropriately decorated and is comfortably furnished. Some individual bedrooms were seen and had been decorated, furnished and personalised according to the needs and preferences of the individual occupant. Two service users were happy to show me their rooms and clearly enjoyed having their own space. The communal areas were spacious and had been arranged to meet the needs of current service users. There is a garden for the use of service users that is well used during warmer weather and included a vegetable garden that is used by one service user in particular. It was noted that the kitchen was old and in need of replacement, documentation seen provided evidence that the kitchen is due for complete renewal but as yet a firm date is not known. Maintenance issues are raised when identified and are logged by email. Currently the process of follow up is left for senior staff to remember to chase when issues have not Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: been addressed. This is system is not efficient and delays in maintenance were reported by staff. The Business Manager reported that the organisation was looking at the system as a whole to ensure that it is more efficient. Long standing maintenance issues such as the heating system, which remains on during very hot weather are being addressed through capital expenditure to replace the system but no completion dates have been confirmed. The home has laundry rooms within the flats and an additional room in the downstairs area. COSHH materials are now always stored in locked cupboards to which service users do not have access. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience 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, trained and qualified staff and are protected by the homes recruitment policies and practises. Evidence: The organisation provides a comprehensive staff training programme that includes National Vocational Qualification training, specialist learning disability awards and ongoing core training including moving and handling, food hygiene, fire awareness and safeguarding adults. All new staff are required to undergo induction training to Skills4care standards and guidelines. The training department notifies services when updates or refresher training is due for individual staff. This service has not always acted promptly to required updates and this has resulted in many staff requiring refresher training in a range of areas. The A grade provided evidence that refresher training had been booked for all staff. Each staff member has a training profile where copies of training certificates are maintained. Overall staff appeared confident in their roles and were committed to working as a team for the benefit of service uses. A shift planner is posted in the hallway and now includes relevant photographs of staff on duty enabling service users to see who is working in the home. Staff meetings are now held regularly and minutes seen confirmed that staff are being given clearer directions on their roles and responsibilities through these meetings and through individual supervision. The organisation has a robust recruitment system that is administered Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: centrally. Evidence was accepted from information provided by the service and from knowledge of the organisation that no staff member commences employment within the home without having provided all the necessary documentation as dictated by the regulations. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is now better managed and is working towards an ethos that reflects the views of service users. The health, safety and welfare of service users are promoted and protected. Evidence: The service has been managed by a qualified and registered manager. As a result of findings from the recent random inspection and from the last regulation 26 visit an external investigation was implemented. This has led to the suspension of the current manager. The organisation has provided temporary management arrangements that have included two registered managers overseeing the service jointly whilst retaining management responsibilities for their own homes. In addition, an A grade has been providing morning input to support the review of all documentation. According to the organisations own policies and procedures the service should be monitored in various ways including the use of Regulation 26 visits and lay monitoring visits. In practise, since the expansion of the service that included four additional service users, all of whom exhibit challenging behaviours on occasions, the frequency Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: of Regulation 26 visits has been poor. In 2010 one visit was carried out in January followed by a visit in May 2010 shortly before the CQC random inspection visit. It was at the latest visit that the deterioration of the service was noted and action was commenced to address the shortfalls. However, difficulties were noted from external management visits as far back as September 2009 but the organisation failed to provide adequate direction or support at that time. A wide range of health and safety checks are now regularly undertaken. It was difficult from previously seen records to ascertain whether all required checks were being conducted according to the requirements of the legislation and the organisation. A full fire evacuation of the upstairs flats was recently undertaken and was confirmed in documentation seen. A similar exercise had not yet occurred in the downstairs area due to concerns about the potential for causing anxiety, stress and potential challenging behaviour for those service users living there. The current management group were aware that this needed to be addressed without undue delay and undertook to ensure that some system for practising an evacuation was implemented. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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