Care Home: Avoca Care Home

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What the care home does well There are good systems in place to help anyone thinking about moving into Avoca. People can visit as often as they want and stay overnight. Staff meet with them to find out about the support they need and the things they like to do. This helps everyone to decide if Avoca is the right place for the person to live. A book about Avoca is given to everyone living there or thinking about moving in. This uses pictures and words that are easy to understand. It helps everyone to understand as much as possible about Avoca and the support they can expect. People can make their own decisions about their everyday lives. For example things like what time to go to bed or what to eat. Staff also help people to make bigger decisions. The people living at Avoca get good support to look after their health. Staff support them to go to appointments. They also know how to support people if they are not well. The people living at Avoca know who to talk to if they are unhappy about something. They are confident that staff will help them and sort it out for them. People told us that they like the meals at Avoca. They said they can always choose what they want to eat. They told us that they can make a drink or have something to eat whenever they want. The staff who work at Avoca know the people who live there very well. People told us that they like the staff who support them. Staff spend time chatting with people as well as supporting them with the things they need. Staff get lots of training to help them support the people at Avoca safely and well. What has improved since the last inspection? Everyone living at Avoca has care plan in place. These plans are written with the person and kept up to date. This means that people are as involved as possible in the support they get. It also means that staff know how to support the person in a way they prefer. Risk assessments are in place for the things people do and the support they need. They look at how to lessen any risks whilst still supporting the person to do the things they want or need to do. The way that Potensials support people to look after their money is a lot clearer than it was. This means that it can be easily checked to make sure it is being managed well for the person. The people living at Avoca are more involved in looking after their home. They go shopping for food, look after the garden and do some housework. This helps people to become more involved in the running of their home What the care home could do better: Plans are in place to decorate Avoca. This will make it a more homely and up to date house to live in. The people living at Avoca should be asked if they want to be involved in interviewing new staff. They should also be asked if they want to have more house meetings. This will give them a more formal way to be involved in the running of their home and planning improvements. When staff hand write people`s medication they should get another member of staff to sign it. They should not use sticky labels to write the tablets people are taking. This will help to make sure medication is managed safely. The times staff work and the number of staff who work should be looked at. This will help to make sure there are enough staff to support people to get out and about. Key inspection report Care homes for adults (18-65 years) Name: Address: Avoca Care Home 52 Mosspits Lane Liverpool Merseyside L10 9LQ     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: Lorraine Farrar     Date: 1 6 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Avoca Care Home 52 Mosspits Lane Liverpool Merseyside L10 9LQ 01514744132 01514744132 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Potensial Limited Name of registered manager (if applicable) Ms Julie Greene Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of people who can be accommodated is: 7 Date of last inspection Brief description of the care home Avoca is owned and operated by a company called Potensials. They provide care and support services to people across the country. It is registered to provide support and accommodation for seven adults who have learning disabilities. The house is an end terraced based in a family area of Fazackerly. It is within reasonable distance of local shops, facilites and public transport. Accommodation consists of a shared lounge, dining room, domestic kitchen and laundry. In addition there is an upstairs bathroom with accessible shower and bath and a downstairs shower room with seperate toilet. Care Homes for Adults (18-65 years) Page 4 of 30 0 9 0 1 2 0 0 9 7 Over 65 0 Brief description of the care home Everyone living at Avoca has their own en-suite bedroom that they can personalise as the choose. Outside an enclosed rear garden provides seating areas. Some parking is availalbe on the drive with additional parking on the street outside. Staff work at Avoca twenty four hours a day to support the people living there. Care Homes for Adults (18-65 years) Page 5 of 30 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: We gathered information for this inspection in a number of different ways. Before we visited we reviewed information from our last inspection which took place in January 2009. We also reviewed any information that we have received about the home since that time. We carried out an unannounced site visit on 16 July 2009 for 6.10 hours. An Expert by Experience accompanied us for part of the visit. An Expert by Experience is someone who has used services for people who have a learning disability and has had training in the inspection process. During the site visit the Expert spoke to the people living at Avoca and to staff and looked around the environment. Following the site visit they wrote a report of their findings for us. This is taken into account when writing this report. Whilst we were at Avoca we spent time looking at the support the people living there Care Homes for Adults (18-65 years) Page 6 of 30 receive. This included looking at the support they get with their daily lives, care plans, money medication and environment. We talked with the five men who live there and with three members of staff including the manager. This helped us to find out what it is like to live at Avoca and if people get the support they need and choose. It costs between four hundred and sixty one pounds, thirty three pence and seven hundred and sixty three pounds and sixty seven pence each week to live at Avoca. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? Everyone living at Avoca has care plan in place. These plans are written with the person and kept up to date. This means that people are as involved as possible in the support they get. It also means that staff know how to support the person in a way they prefer. Risk assessments are in place for the things people do and the support they need. They look at how to lessen any risks whilst still supporting the person to do the things they want or need to do. The way that Potensials support people to look after their money is a lot clearer than it was. This means that it can be easily checked to make sure it is being managed well for the person. The people living at Avoca are more involved in looking after their home. They go shopping for food, look after the garden and do some housework. This helps people to become more involved in the running of their home Care Homes for Adults (18-65 years) Page 8 of 30 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 9 of 30 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 10 of 30 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. Sufficient information is obtained about and given to people considering moving into Avoca. This helps everyone to decide if Avoca is the right place for the person to live. It also helps staff to plan with the person, how they will meet their needs and choices. Evidence: Nobody new has moved into Avoca for some time, therefore it was not possible for us to practically assess the support the home would offer. However we discussed this with the manager who explained the process she would follow. Once somebody expressed an interest in moving into Avoca, staff would meet with them and start assessing their needs and choices. The person would be invited to visit the house several times and to stay overnight if they wished. This would give them the opportunity to meet the other people living there, meet staff and get to know a bit about how the home works. A new booklet has been put together to tell people about Avoca. The expert by experience looked at this booklet with one of the people living there and said I thought it was very good. It gives people information about the local area and the Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: support people can expect with their health and lifestyle. It also tells people about how they can make a complaint and the process for choosing a new home. The booklet uses pictures and photographs and is written in a way that is easy to understand. The systems for getting information about people and giving them information about the home helps everyone to decide if Avoca is the right place for the person to live. It also helps staff plan how they will support the person successfully. Care Homes for Adults (18-65 years) Page 12 of 30 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. Staff work with the people living at Avoca to identify their needs and choices and plan the support they need to meet these so they take an active part in planning their own lives. Evidence: Individual care plans are in place for all of the people living at Avoca. The people living there told us that they are aware of their plans and the contents with one person explaining, my key worker talks about it. Care plans contain information about the persons health, their daily routines and lifestyles. Where the person needs support a detailed care plan is in place to provide guidance for staff on the support the person needs and chooses. A monthly review of care plans is held with the person who then signs their review. Writing care plans with the person and regularly updating them helps to ensure that people are as informed as possible about the support they can expect to receive. It also provides a clear way for any changes to the persons support or lifestyle needs and choices to be quickly Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: identified and acted upon. The expert by experience commented that people should be given the opportunity to, do person centred planning to look at hopes and dreams and choices in their lives and to see if they want to do different things. In discussions with the manager she explained that they are in the process of working with the people living at Avoca to make plans more person centred. She was able to give examples of the things people had discussed in their initial meetings and how these were being met. For example one person wanted a pet for their bedroom and he explained to us that he had been to buy this after agreeing guidelines with staff. This is good practice as it enables people to discuss the things they would like to do in the future and if possible plan how to make them happen. The manager also explained that once completed they are looking at different ways to format the plans, for example putting them onto tape for one person. Again this helps people to understand as much as possible about the support they can expect to receive. Comprehensive risk assessments form the basis of everybodys care plan. These cover all aspects of the persons life and identify if there is a risk and the level of risk. If a high risk is identified then a separate assessment is completed along with a care plan to provide clear guidance to staff on how to support the person in a way that minimises the risk whilst still enabling them to do the things they wish to do. People told us that they can make everyday decisions about things for themselves and one person explained, I have my own free will, nothing to stop me. I just get on, thats why they call it your home. Information about local advocacy services that will support people to speak up for themselves is readily available in the home and records showed that the manager had supported one of the people living at Avoca to request an advocate. People told the expert by experience that regular house meetings are held at which they can discuss things like food, choices and holidays. This all helps to ensure that people are able to make their own decisions, with support if needed. Care Homes for Adults (18-65 years) Page 14 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Avoca are supported to live at lifestyle of their choice. However as their needs are changing this support may need to be reviewed to ensure it still meets peoples needs and choices. Evidence: During our visit we observed that the people living at Avoca choose how to spend their time at home, with some people spending time socialising in the lounge and others spending time in their room watching TV or DVDs. Plans were under way for a birthday tea that evening and staff explained that the persons relatives had also been invited to attend. One of the people living there told us that staff will support them to go on holiday if they wish, explaining to us, I am going on holiday, its getting sorted out. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: The people living at Avoca had varied opinions on the amount of support they get from staff to go out and about. One person told us he can do what he wants, I just say I want to go out. Another person told us they would like to go out more as it can get a bit boring. People also told the expert by experience that they would like to go out more and to different places. Records in the home showed that staff do provide some support for people to go out and about. For example records showed support had been provided to people to go shopping, to the pub, to eat out and go to a local fair. However the needs of the people living at Avoca are changing and some people are not as able to go out and about on their own as they have been in the past. Therefore staffing levels and routines may need to be altered to ensure people can take part in their local community and activities as much as they wish. The people living at Avoca do go to local colleges or day centres and the manager explained staff have been supporting one person to look into getting a volunteer job. This all helps people to maintain and make new friendships and spend their time doing things they enjoy. People are able to go to church if they wish to and care plans give clear information about peoples religious beliefs and any support they need to maintain these. Some of the people living at Avoca told the expert by experience that they have friends whom they see in their local community and in discussions with some of the people living there they confirmed to us that they can have visitors whenever they want. Routines at Avoca are flexible with people telling us they can do the things they want to do at home. We observed that staff respect peoples privacy, for example knocking on their bedroom doors before entering and giving people their post unopened. Since our last inspection at Avoca the people living there have started to become more involved in the everyday running of their home. For example doing the garden, housework and food shopping. This helps to give people a more ordinary lifestyle and more direct control over the running of their home. Food is bought at local shops and supermarkets and records showed that the people living at Avoca go with staff for the food shop. People told us the food is, all right and I like it. They also told us that staff make the main meals but they can make a drink or snack whenever they want. One person told us they sometimes get a cooked breakfast which they think is lovely. Another person explained, I do my own dinner (lunch), make drinks, eat and drink what I want. Records of menus showed that meals are varied with plenty of fruit and vegetables offered. Each week everyone Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: living at Avoca chooses a favourite meal to be made during the week. Care Homes for Adults (18-65 years) Page 17 of 30 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. The health and personal care needs and choices of the people living at Avoca are recognised and staff provide support to meet these in a way the person prefers. Evidence: The people living at Avoca told us that they get help with their health and personal care when they need it. People also told us that routines in the house are flexible, for example they can get up and go to bed when they choose. During our visit to Avoca staff were supporting one person to attend a health appointment and records showed that this support is regularly provided for people to attend both regular and emergency health appointments. Care plans contain clear guidance for staff to follow when supporting people with their personal care. These list both the support people need and the areas they are more independent in. Discussions with staff evidenced that they have a clear understanding of the support people need with their personal care and their health and how to provide this in a way the person prefers. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: Health action plans are in place for the people living at Avoca and had been signed by the person. They give clear information about the persons health history, their medication and the support they need. Peoples weight is monitored regularly and if they have seizures these are recorded. The records and care planning help to ensure that people are getting the support they need with their health and that any changes can be quickly noted and acted upon. None of the people living at Avoca manage their own medication. However in discussions they told us that they are happy for staff to manage this on their behalf and that they get their medication when needed and on time. Medication is stored safely in a locked cabinet in the office. When medication is received staff check it and record the amount, they then carry out weekly audits of the medication in the home. This regular checking helps to lessen the risk of mistakes occurring and ensure any issues can be quickly noted and acted upon. We checked a sample of medication in the home and found that this tallied with records. Medication administration sheets (MAR sheets) are used to record the medication people are taking and when this is given. Where entries are handwritten these have not been signed or double checked by another member of staff. It is good practice to have two members of staff sign a handwritten entry as it lessens the risk of an error occurring. One MAR sheet had a medication on that had been stopped by the persons doctor. Staff had used a sticky label to cover this up and write the newly prescribed medication on. A sticky label is not a permanent record of the medication someone is taking and means records may not be totally accurate if checked in the future. Care Homes for Adults (18-65 years) Page 19 of 30 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 at Avoca are confident that any concerns or complaints they have will be listened to and acted upon. This helps people to feel safe whilst living there. Evidence: The people living at Avoca all know who they would talk to if they had any concerns or complaints and were confident that staff would help them. People told us that they would speak to the manager or to staff. One person told us that staff would sort it out for them. Information about how to make a complaint is made available to everyone via the information booklet they are given. Staff have had training in safeguarding adults procedures. In discussions with staff who work at Avoca they displayed a clear understanding of these issues, the signs they would look for and the actions they would take. The awareness staff have along with the fact that the people living there are confident they will be listened to and their concerns acted upon, helps people to feel safe whilst living at Avoca. No concerns, complaints or protection issues have been raised about Avoca since it was registered in August 2008. Potensials acts as appointee for the benefit money of most of the people who live at Avoca. We checked samples of records and amounts held in the home for people and found that these tallied with clear records kept of monies spent. Since our last inspection clear records of how peoples money is managed for them are available. In Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: addition a finance care plan is in place for the people living there. One person explained to us that they could have their money whenever they wanted and that they prefer it to be looked after by staff. They also explained that they have their own bank account and staff accompany them to the bank when they need to go. This open approach to supporting people with their money helps to ensure a clear audit trail is in place and that peoples money is managed in their best interests. Care Homes for Adults (18-65 years) Page 21 of 30 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. Avoca provides people with a comfortable, family style home to live in that has been adapted to meet their needs and choices. The on-going decoration and renewal plan will help to bring the environment up to date. Evidence: Avoca is an end terraced house in a family area of Fazackerly and fits in well with other houses in the local area. Everyone living at Avoca has their own bedroom, with en-suite toilet and sink. We noticed that people are able to personalise their bedrooms to meet their interests and hobbies. In addition to the en-suite toilets in bedrooms Avoca also provides an upstairs bathroom with bath and accessible shower and an accessible shower downstairs. Grab rails and a ramp are available to help people with their mobility. The people living at Avoca share a lounge, dining room, and domestic kitchen. The expert by experience commented that, the house could do with re-decoration, new furniture and carpets and that it, needed more personal touches, although there were lots of holiday photos it was a bit bare otherwise. However one of the people Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: living there had told her that he thought the place was being done up soon. In discussions with the manager she explained that there are plans to decorate some areas and purchase a new suite for the lounge. She also explained that an on-going decoration and renewal plan was being put into place and this would all be done in consultation with the people living there. Outside there is a back garden with paved seating areas. The people living at Avoca and staff have begun work on the front garden. One of the people living there has grown plug plants and these have been planted in a small flower bed. As the garden at the front is fairly private a small table and chairs have also been added. One of the people living there told the expert by experience that there is a lawn mower but no hedge trimmers. She commented that the hedges are overgrown and would benefit from being trimmed. Parking is available on the street at the front of the house. There is a small laundry room with a washer and drier; this room was clean and tidy. Supplies of disposable gloves, aprons and liquid soap are available and some staff have had training in infection control. This all helps to prevent or minimise an outbreak of infection. Care Homes for Adults (18-65 years) Page 23 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Avoca are supported by a knowledgeable and experienced staff team whom they have confidence in. However as peoples needs change staffing levels may not be sufficient to ensure people get support as often as they would like, in all areas of their lives. Evidence: The people living at Avoca told us that they like the staff who work there. One person told us, I think they are good and another that, I get on with them. The expert by experience commented that she found staff, very kind and polite and welcoming. Staff we spoke with had a good understanding of the people who live at Avoca. They were able to explain the different support and health needs people have as well as their likes and dislikes and their chosen lifestyles. We observed during our visit that staff have built good relationships with the people living there, who clearly felt comfortable in their company. Some of the people living at Avoca told the expert by experience that they felt there are not always enough staff to support them to go out when they wish to. The expert commented that this does not have to be paid members of staff but could be volunteers or befrienders etc. There are vacancies in the home and the manager Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: explained that she was in the process of recruiting to fill these, with interviews taking place on the day of our visit. Currently the people living at Avoca are not involved in interviewing for staff, although one person told the expert by experience that they would like to be. This would provide a good opportunity to support people to become more involved in the running of their home. The staff rota showed that there are two members of staff working in the house during the day with one staff awake at night. As the needs of the people living at Avoca are changing, these staffing levels may need to be reviewed to ensure that people can get support in all areas of their daily lives, including getting out and about in their local community. No new staff have started working at Avoca since Potensials took over in August 2008. However staff files for existing staff showed that records of checks such as references and Criminal Records Bureau (CRB) checks are on file. The manager told us in the self assessment form that, stringent recruitment procedures are in place and would be used. This helps to ensure that staff are suitable to work with people who may be vulnerable. In discussions with a member of staff they told us that they are, always training and had had some really good courses in the past few months that had improved their knowledge of how to support the people living at Avoca. Records showed that staff have undertaken a variety of training in different aspects of supporting people. These range from areas of health and safety such as infection control and moving and handling people to more specialist areas such as epilepsy and the Mental Capacity Act. The training staff have had and that is planned helps to ensure staff are as up to date as possible in how to support people safely and well. Care Homes for Adults (18-65 years) Page 25 of 30 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. Avoca is well managed for the benefit of the people who live there. Evidence: The registered manager at Avoca is experienced in managing care services for adults who have a learning disability and holds qualifications in care and management. She undertakes regular training to ensure she is up to date with new laws and practice in supporting people safely and well. Staff told us that they find her approachable and in discussions it was clear that she has firm plans to continue to improve the service provided at Avoca. As the registered manager is also registered to manage another care home nearby, she spends a minimum of two days a week at Avoca. At the time of our visit interviews were being undertaken to appoint a full time deputy manager for the home. This will help to ensure that there is a consistent management team in place at all times. There are several systems in place at Avoca for checking and improving the service Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: that they offer. This includes regular reviewing of care plans with the people living there. In addition the manager has put together a clear development plan. This lists improvements and tasks that will be carried out each month. For example the plan for July covered staff training, care plans and decoration. In addition a monthly audit of the service is carried out. This covers all aspects of the service provided, including, health and safety, money, medication, support with activities and care plans. These audits and plans help to ensure that any issues can be quickly identified and action taken to further improve the service. Although the people living at Avoca meet with their key worker each month to discuss their care plan and support, the last formal service user meeting that took place before our visit was in March 2009. More regular meetings with the people living at Avoca would help to involve them more in the running of their home and planning future improvements. Regular checks are carried out on the building and equipment at Avoca; this includes checking portable electrical appliances, fire systems and electrics. In addition risk assessments are completed and reviewed for areas of the building and tasks such as cooking and gardening. These checks help to ensure that Avoca is a safe place to live, work and visit. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 1 20 Where a medication is handwritten on MAR sheets, this should be checked and signed by two members of staff. This will lessen the risk of an error occurring. Sticky labels should not be used on MAR sheets as they do not provide a permanent record of the medication people are taking. 2 32 Staffing levels should be reviewed to ensure they meet the changing needs of the people living at Avoca. This will help to ensure sufficient support is available to enable people to live a lifestyle of their choosing and get out and about. The people living at Avoca should be supported to take part in the recruitment process for new staff. This will help them to take a more active part in the running of their home The views of the people living at Avoca about the service they receive should be obtained more regularly and recorded. This will provide them with a more formal way to be involved in the running of their home and planning improvements. 3 34 4 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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