Care Home: Durham Avenue

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What the care home does well Durham Avenue care home has a group of staff that work well together. A good standard of personalised care is provided for the people that live there so that the individual needs, wants and wishes of each person can be met. It was observed that there was a very friendly and comfortable relationship between residents and the staff team that helps to make people living at the home feel valued, safe and secure. The social, health and personal care support that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice so people living at the home can be confident that they will be well cared for. The routines of the home are flexible and aim to allow residents their freedom and independence by enabling them to retain as much control over their lives as possible, thus promoting equality and diversity. People are enjoying a good quality of life and are involved with a range of activities both in the home and the local community. There was good recognition of the importance of staff training. This is given high priority in order to ensure that the staff team have the right skills and knowledge to provide a good, consistent service that meets people`s individual needs and choices. A support worker spoken with was very pleased to have successfully achieved an National Vocational Qualification (NVQ) in care and is now to undertake a higher level of this award. This will not only be of benefit for the people living at the home but also for the personal development of the care worker. What has improved since the last inspection? Since the last key inspection, all support workers working at the home have now achieved at minimum an NVQ (National Vocational Qualification) Level 2 in care. This is commendable and helps to ensure that the staff team have the skills and abilities to provide a good, consistent service for the people living at the home. Portable heating equipment, that is sometimes used in some resident`s individual bedrooms, has now been safely stored away unless actually needed. As recommended at the last inspection, risk assessments are now in place regarding the portable heaters. This helps to keep people safe and also helps to prevent accidents from occurring. Some improvements have been made to the physical environment of the home. Residents enjoyed a holiday at a Centre Parc while the home was being rewired, a new bathroom has been fitted and at residents request, an additional toilet has been provided. Some major roof work has been completed to replace roof tiles that were damaged in a storm, more windows have been replaced by double glazed units and the side of the house has been re-pointed. The existing outdoor shed has been provided with electricity to create a smoking area for the only resident that enjoys a cigarette. This has all helped to provide a more comfortable place for people to live that meets their preferences. The home has also successfully achieved the `Investors in People` award (an external quality assurance monitoring organisation) demonstrating that there is a commitment to have the quality of care provided, assessed both internally and externally. What the care home could do better: The staff team try very hard to provide a good service that meets residents needs and expectations. However there are a small number of things that could be done to improve the service further. It has been suggested that a comprehensive staff training matrix could be developed. This would help to provide a clear and easily accessible record of the training each member of staff had already successfully completed, help to identify further training requirements and clearly highlight when refresher training is due. Although it was clear that staff do receive regular formal one to one supervision, the supervision records were not always signed and dated. It is important that a chronological record is maintained of all supervision so that individual progress can be monitored and also to confirm that the topics highlighted on the supervision record were discussed and agreed. Whenever a risk is identified, a formal risk assessment should be in place. This would provide staff with clear detailed instruction of what to do should an incident occur. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Durham Avenue 13 Durham Avenue St Annes On Sea Lancashire FY8 2BD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Upton     Date: 0 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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: Durham Avenue 13 Durham Avenue St Annes On Sea Lancashire FY8 2BD 01253640880 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr David Calwell care home 3 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 service users in 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 service users who can be accommodated is: 3 Date of last inspection Brief description of the care home Durham Avenue Care Home is currently registered to accommodate up to three adults who have a learning disability. The home is located in a quiet residential area of St Annes but within easy reach of the main shopping centre of the town, community facilities and resources. Communal areas of the home are domestic in character and each resident is accommodated in single bedroom accommodation. Residents access and enjoy local community facilities and are an accepted part of their community. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 3 Brief description of the care home The staff group ensure there is a homely and comfortable atmosphere in the home and that residents are enabled and empowered to maintain and maximise their independence as far as possible. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on outcomes for the people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The unannounced site visit took place during a mid week day and spanned a period of approximately five hours. At the time of the site visit, three people were living at 13 Durham Avenue. Twenty three of the forty three standards identified in the National Minimum Standards - Care Homes for Younger Adults were assessed along with a reassessment of the requirements and recommendations made at the last key inspection. We (The Care Quality Commission - CQC) spoke with the registered homeowner/manager, the second homeowner who also works at the home and the support worker that was on duty. In addition, although conversation was limited, we spoke generally with the two residents that were at home during the course of the site Care Homes for Adults (18-65 years) Page 6 of 34 visit. This helped to form an opinion as to whether the home was meeting the needs and expectations of the people who live there. Information was also gained from the annual quality assurance assessment (AQAA) completed by the registered manager prior to the site visit taking place. This is a self assessment that focuses on how well positive outcomes are being achieved for people using the service. A number of records were viewed and a tour of the building took place including communal areas of the home, bathrooms and individual bedroom accommodation. Time was also spent observing the relationship between staff and residents as they went about the days activities. Details of current fees and what is included in the fees is available from the home. The last key inspection took place in September 2007. In July 2008, an Annual Service Review took place. An annual service review is a report that we write for good or excellent services that have not had a key inspection in that current inspection year. This does not routinely include a visit to the service. The review is an analysis of all the information that we have gathered about the service since the last main inspection. The report relating to this Annual Service Review is held at the CQC office and would be made available on request. What the care home does well: What has improved since the last inspection? Since the last key inspection, all support workers working at the home have now achieved at minimum an NVQ (National Vocational Qualification) Level 2 in care. This is commendable and helps to ensure that the staff team have the skills and abilities to provide a good, consistent service for the people living at the home. Portable heating equipment, that is sometimes used in some residents individual bedrooms, has now been safely stored away unless actually needed. As recommended at the last inspection, risk assessments are now in place regarding the portable heaters. This helps to keep people safe and also helps to prevent accidents from occurring. Some improvements have been made to the physical environment of the home. Residents enjoyed a holiday at a Centre Parc while the home was being rewired, a new bathroom has been fitted and at residents request, an additional toilet has been provided. Some major roof work has been completed to replace roof tiles that were damaged in a storm, more windows have been replaced by double glazed units and the side of the house has been re-pointed. The existing outdoor shed has been provided with electricity to create a smoking area for the only resident that enjoys a cigarette. This has all helped to provide a more comfortable place for people to live that meets their preferences. The home has also successfully achieved the Investors in People award (an external quality assurance monitoring organisation) demonstrating that there is a commitment to have the quality of care provided, assessed both internally and externally. Care Homes for Adults (18-65 years) Page 8 of 34 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 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 9 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 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to access and monitor individual needs, ensuring that a suitable service is provided based on personal needs and preferences. Evidence: The three people living at Durham Avenue care home have all lived there for a long time and know each other very well. As there are no vacancies at Durham Avenue, there have been no admissions to the home for a considerable period of time. However there is a structured pre admission assessment system in place to make sure that people would only be admitted to the home if their individual needs and choices could be met. Compatibility with residents already living at the home would very much be taken into account to make sure that residents got on well with each other. The prospective resident, their family members/supporters, Social Services and any other agency involved in the care of that person are consulted and involved in the pre admission assessment. This helps to ensure that the requirements and wishes of the prospective resident are clearly understood. Pre admission visits to the home are also arranged at a pace that is suited to the individual. This gives opportunity to meet the Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: staff group and the people that live there. Relatives are involved as much as possible both to support the individual and to help provide additional information. Diversity and equality issues in respect of each prospective resident are given close attention. This is to make sure that individual care needs, interests, hobbies, sexuality, religious and cultural beliefs are taken into account, respected and addressed. Information about the home is produced in a pictorial format and complimented by written material. However the home has recently bought a computer Boardmaker programme and it is anticipated that the pictorial and written information given to residents and prospective residents about the home and the services provided will be updated using the new computer soft wear. Only when the full assessment process is completed, including taking into account the views and thoughts of the prospective resident, will a decision be made as to whether an appropriate service could be provided at the home. Observation of care files confirmed that although some time ago, thorough pre admission assessments had been conducted prior to each person moving into the home. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Durham Avenue care home are able to make choices about their lifestyle and are helped to maintain their independence so life at the home meets their expectations. Evidence: The staff team have worked hard with people who use the service, developing care plans that are unique to them so that they receive the right amount of support and care that meets their needs. This ensures as far as possible, that people using the service are supported to make their own informed decisions and have the right to take managed risks in their daily lives enabling them to be as independent as possible. Each resident has an individualised and detailed, person centred care plan. Good care plan records have been developed to make sure staff can meet peoples assessed and changing needs and their personal choices and dignity are respected at all times. Each area of need is supported by a separate care plan. This included topics such as Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: education, family/social contact, income, culture and faith, personal care, physical and mental health, communication, challenging behaviour and compatibility. This enabled staff to provide an individualised, person centred service delivered in a consistent way. This also helped to make sure that residents were encouraged to do what they could for themselves and promote independence whilst ensuring that all staff were giving the same amount of help when required. In the main, individual risk assessments and risk management strategies are in place. This helps to protect people from risk or harm. Risk assessments are regularly reviewed to make sure that the information remains current so that any identified risks are, as far as possible, eliminated or minimised. However at the last inspection, it was recommended that a specific risk assessment be developed in respect of one person living at the home. This has not been done. Although we were told that this specific risk is now very low, a risk assessment should never the less be in place to make sure that staff have clear written guidance should an incident occur. Likewise if there is any suggestion that a resident may self harm in any way, a formal risk assessment should be in place to advise staff of the triggers that may precipitate an incident, what action staff should take to defuse the situation and how to lessen the possibility of an incident occurring. Each resident also has an individual health action plan, weekly activities and daily activities plan, and a All About Me plan that had been developed in an easy read and pictorial format to make the All About Me plan more meaningful for the resident. The health action plan, activities plans and the All About Me plan is agreed and where ever possible, signed by the resident and the manager. This shows that residents are involved in their support plans and can have their say in what they want the support plans to say for staff to follow. A review of individual care plans and risk assessments take place on a regular basis. For one resident it was evident that a formal Social Services annual review had recently take place. A staff survey was received from one member of staff working at the home. This person told us that new information is always updated in meetings and the support worker spoken with said that communication within the staff team was very good and that there was always good written information available in order to provide a consistent service in a individualised way. It was very clear from observing the interaction between the two residents that were at home during the site visit and the staff that were supporting them, that there was a very comfortable and relaxed atmosphere that residents responded well to. There was very much a family type atmosphere and it was also clear that each residents Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: individual needs and requirements were well known by the staff team and responded to with care and understanding. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are organised according to peoples preferences and staff provide good support to ensure that family and friendship links are maintained. Residents benefit from a well balanced diet that suits their taste and choice. Evidence: Residents are supported to take part in meaningful and appropriate activities as part of their chosen lifestyle. Each person has a weekly plan of activities, detailing the social activities planned for the coming week which reflects their own likes and preferences. These were clear and individualised to the specific choices and interests of each resident. People were enjoying a good quality of life and were involved with a good range of activities both in the home and local community. One resident told us that the activity scheduled to take place on the morning of the site visit had taken place that day. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: On the day of the site visit, one resident was returning home from a long weekend away with a support worker from the home. This particular resident has a keen interest in aircraft and had spent the weekend at an air show in another part of the country. The two other residents living at the home were very excited about the return of their fellow resident and were looking forward to hearing all about the holiday. Two of the residents have also enjoyed a week long holiday at a Centre Parc, and one resident is also supported to visit her sister in Spain. Another resident has indicated that she would like to attend a college course so an appointment has been made to see what courses are available. The staff team are also looking at the availability of Aqua Aerobics for one resident that has asked about swimming. Another resident enjoys gardening and there is a greenhouse in the outside area where vegetables and flowers are grown. This has also encouraged healthy eating and through art work, residents are being educated regarding healthy eating by being encouraged to draw or cut out fruit and vegetables. We were informed in the AQAA that residents then compiled a five a day chart which helped them to choose healthier eating options when deciding on meals. Residents are supported to go shopping and select the foods they have chosen to eat. The AQAA (Annual Quality Assurance Assessment) is a document completed by the homeowner/manager prior to the site visit taking place. This provides information on the services strengths and weaknesses, any future development plans and helps us to determine if the management of the home see the service they provide in the same way that we do. There is a separate smaller lounge where residents can choose to spend time alone or alternatively may choose to join in-house activities in another area of the home. Residents also attend a dance class organised by a local resource centre as well as enjoying art and craft activities at home. Residents have access to a car so that staff can assist and support them to to go further afield on trips out. One resident has a special interest in museums and another resident, as previously stated, enjoys aeroplanes. Trips out are catered round these interests and any other areas of interest that residents have expressed. Durham Avenue Care Home has a sister home nearby accommodating the same number of people. Residents from both homes often enjoy each others company and a resident from one home may choose to go out with a resident(s) of the other home with staff support to enjoy a leisure or recreational activity. The majority of residents at both of the homes have known each other for a long time and good friendships have developed. This shows that residents are encouraged to socialise with people of their choice, at a time of their choice, in an activity of their choice. Daily routines at the home are flexible and adapted to fit in with the days activities. Information in the Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: AQAA showed that residents contribute to the household chores, choose their own tasks and take a pride in their work. Residents are also encouraged where possible to contribute to the preparation of food, cooking meals and tidying up afterwards. This supports choice and self determination regarding daily living activities. Residents also enjoy eating out in cafes, bars and restaurants. There is a four weekly menu option but menus are flexible and determined by what residents choose to eat on any particular day, whilst still encouraging healthy eating. This includes pictures of food items to enable residents to make positive choices before the shopping list is completed. There is also a money chart showing the shape and colour of notes and coins to help residents gain some knowledge of money and money management. Each Monday there is also the Lord Durham fit club. Residents are fully involved in this in order to chart progress regarding weight loss and to encourage a healthy eating plan. Family and friendships links are positively encouraged. Friends and family are welcome to visit at any time and staff are active in ensuring that good communication is established and maintained. The homeowner/manager again explained that a birthday list and a list of other special events is kept, and with staff support, cards and presents are bought and delivered on time. Families and friends are invited to birthday parties and at Christmas and all maintain a good relationships with others family and friends. This helps to create a strong sense of family involvement and encourages residents to continue to be very much a part of their family. Two of the residents have close family living abroad, so telephone contact is maintained regularly and letters sent, usually after an event has taken place such as a holiday. Residents are enabled to vote at local and government elections and there was also evidence of residents having their own last will and testament. This helps to demonstrate that people living at the home are encouraged and supported to make important and valued decisions about their lives. It was clear that there is a good rapport between people living at the home and the staff team. It was also evident that respect, privacy and dignity are promoted within the home. One member of staff told us on a Care Quality Commission (CQC) survey that, The home always has an excellent atmosphere, everyone loves working together - the service users always feel relaxed and part of a family and are always involved in their life decisions. One service user always asks me, would I like a cup of tea? and then makes it for me, they love it when people come visiting, its a proper home. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Promotion of health is taken seriously, peoples welfare is monitored and health care needs are met. Evidence: Each individual resident has a health action plan giving clear information including health care appointments and follow up visits to ensure that each residents personal and health needs and requirements are met at all times. The manager and one other member of staff have undertaken training in the facilitation of health action planning. It is anticipated that all staff members will eventually be provided with this training. The individual care plan of each resident provides good information regarding the support required with personal care. Each resident has a key worker and files contained guidance regarding any specific personal care need. Staff also receive regular in-house training to ensure that respect, privacy and dignity are upheld at all times. One member of staff has designated responsibility to attend the local Health Action Task Group and report back to the rest of the staff team detailing any changes that may have taken place. Another member of staff has specific responsibility to ensure that all G.P. appointments, dentist appointments etc are kept and all information is fully recorded in each of the residents individual files. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: Durham Avenue care home has a policy and procedures for the safe administration of medication. In the main, medication procedures are adhered to. All staff are required to sign the medication policy to confirm that they have read and understood the content. Staff with responsibility for the administration of medication have all received appropriate medication training. This helps to keep people safe and ensure that support staff have the necessary skills and understanding to manage medicines safely. Medication is securely stored. However on the day of the site visit, although medication had been administered, the medication administration record had not been completed. It is important that as soon as the medication is administered to each resident, this is immediately recorded. If medication is not given for some reason or refused by the resident, this should also be clearly recorded. This appeared to be an isolated blip on an otherwise good system of medication administration. There is a record maintained of medication received into the home and on leaving the home, along with patient information leaflets and written protocols were seen to be in place with regard to a prescribed medication that is only to be taken when required. This provides staff with clear guidance of when required medication should be given to ensure consistency of use. Regular reviews of each residents medication are held with their G.P. This helps to ensure that residents medication requirements are current and helps to prevent medication being taken over a long period of time when it may not be now needed. Residents are asked to sign a consent form to allow staff to administer their prescribed medication or alternatively self administer their own prescribed medication either totally or in part following the successful outcome of a formal risk assessment. Residents have a choice of male or female support staff for assistance with personal care tasks. Staff are alert to any changes of mood or behaviour and know how to respond appropriately. Although individual care plans show whether a particular resident prefers a bath or shower, in reality each resident chooses on a daily basis their preference and the level of support required whilst ensuring that risks are minimised. The AQAA states that improvements could be made in the health action plan to provide details of how the individual would like to be treated should they become terminally ill. The home recently received information about End of Life, (Best Interests) training that all staff will attend and the staff team are currently looking at ways of discussing this sensitive issue with residents. Care Homes for Adults (18-65 years) Page 20 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. Complaints are handled well and taken seriously ensuring people feel listened to. Good safeguarding procedures help to make sure that people remain safe. Evidence: The complaint procedure is made available to all residents and incorporated in the Service User Guide in an easy read and pictorial format to make it more meaningful for residents to understand. Residents personal files contained a complaint card that was also in an easy read format to enable residents to make a complaint if they so wished. If a resident needed support to make a complaint, staff would assist or an external advocate or family member would become involved. At the time of the site visit, both residents spoken with expressed no complaint or concern what so ever. Since the last key inspection, the Commission received an anonymous complaint, part of which also involved the sister home. The homeowner was asked to investigate this internally using the homes complaint procedure. The investigation was thorough with a written record being kept of the complaint, how the complaint was investigated, the outcome of the complaint and any action taken to minimise a further complaint about the same or a similar matter. The Commission received a detailed response with regard to the complaint that was also supported by written documentary evidence. The complaint was not upheld. However this shows that complaints are taken seriously and that the management team viewed complaints and concerns positively as an opportunity to learn and to ensure that a good service continues to be provided. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: During the visit, it was clear that people living at the home had formed good relationships with staff, meaning that any issues could be raised and dealt with informally as part of day to day life at the home. Durham Avenue care home continues to have a variety of policies and procedures in place for the protection of residents. This includes an adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff have received training regarding protection and abuse and this topic also is regularly discussed during one to one supervision and at team meetings. This helps to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. Since the last key inspection, staff have also received independent training with regard to management of aggression. This helps to ensure that residents are protected and that staff have some knowledge of how to defuse an aggressive situation. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). The staff team have also received The Protection of Vulnerable Adults training from a independent training organisation and issues relating to vulnerability, protection and abuse are addressed during initial induction training. The staff member spoken with said she was fully aware of the action to be taken should a complaint, concern or allegation be made to her and would immediately refer this to the registered manager for appropriate action to be taken. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean, pleasant and comfortable environment is provided. Evidence: Durham Avenue Care Home is a mid terrace property that is situated in a residential area of the town. Accommodation is provided on the ground and first floor of the building. The ground floor accommodation consists of a main lounge, smaller lounge and a large kitchen/dining room to the rear of the building. Individual bedroom accommodation is located on the first floor along with a combined bathroom and toilet and separate toilet facility. The home is domestic in character and suits the needs and requirements of the people living there. The property is maintained to a good standard. Personal ornaments give a homely touch and there are photographs displayed of residents and staff enjoying social events. The home is close to the main shopping centre and local services and facilities. All bedroom doors can be locked at the request of the resident. One resident retains the key to his bedroom door. This helps to ensure privacy and dignity. Risk assessments are in place with regard to the remaining two resident bedrooms. A locked facility is also provided for the safe storage of personal items. Residents are encouraged to personalise their own bedroom and choose their own colour scheme for carpets, walls etc and to choose their own furniture or to bring small items from their Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: previous home when they move in. This makes the internal environment very homely and personal for the people who live there. Since the last inspection, various environmental improvements have been made to the home. A full electrical re-wire has taken place, a new bathroom has been fitted, a second toilet has been provided, the outside shed has been supplied with electricity and is now the only smoking area for one of the residents and security lights have been provided at the back of the property. In addition, further new double glazed units have been fitted to some windows, major roof work has been carried out, the side of the house has been re-pointed, new fencing has been installed and one resident has had her bedroom repainted at her request. This has helped to improve the fabric of the property and to provide a warm, safe and comfortable environment for people to live. Both residents spoken with were happy with the accommodation and one of the bedrooms seen was very much personalised with objects that were important to that person. Two of the bedrooms are without central heating at the residents request. Portable heaters are available but not left in the bedroom until actually needed. Formal risk assessments are in place in order to minimise or eliminate any associated risks in using a portable appliance. Laundry facilities are domestic, situated in the kitchen area and suited to the needs of the home. The AQAA stated that all staff have very recently completed or are about to complete infection control training and that food hygiene is a mandatory health and safety training topic that all staff have undertaken. This helps to ensure that staff are aware of current best practice with regard to infection control and how to prevent the possibility of cross infection. Food hygiene training helps to ensure that staff know how to maintain good food hygiene for the protection of residents. One resident also choose to complete the infection control training and now has a certificate to confirm their achievement. Care Homes for Adults (18-65 years) Page 24 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. People receive care and support from staff that they like and who have the skills to support them correctly. Evidence: Information in the AQAA confirmed that there are currently eight support workers who support people in both homes. National Vocational Qualification (NVQ) training is promoted. All support staff have now achieved at minimum a National Vocational Qualification (NVQ) Level 2 in care. This is a nationally recognised qualification for support staff and well exceeds the minimum standard expected. This is to be commended and shows that all staff at the home have the skills, knowledge and understanding to provide a good standard of care. In addition, one member of staff has already achieved a higher level NVQ Level 3 qualification, two further members of staff are currently undertaking this award and one member of the support staff team is undertaking an NVQ Level 4 qualification. One of the homeowners is also about to embark on an NVQ Level 5 in management. This course will take two years to complete. This shows that staff training is considered very important to ensure that the home has a well trained and skilled staff team in order to deliver a high quality service for the people that live there. Durham Avenue care home has a structured recruitment and selection policy and Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: procedures that includes obtaining references and a Criminal Records Bureau (CRB) disclosure before any prospective member of staff could take up their appointment at the home. This helps to protect residents and to make sure that only suitable people are employed. The recruitment records of three recently appointed members of staff were viewed. Records included an application form, two references including one from the previous employer, a criminal records bureau disclosure and a check against the nationally held list of people have been deemed unsuitable to work with vulnerable people. Copies of certificates relating to training completed with their previous employer were also available. For one person there was a considerable period of time between records showing the date the person was appointed and records showing the date the person actually took up employment at the home. From the documents viewed, it appeared that some training with a outside training agency and formal supervision had taken place between these periods. The homeowner explained that new employees are not allowed to take up employment at the home until all the required references and clearances has been received and deemed to be satisfactory. However, if relevant staff training is available, the newly appointed person will be offered this, and be paid for the time taken in respect of the training. After the formal training, supervision is arranged even though the person is not actually in employment. It is important that there is a clear record maintained of the date the person was offered employment at the home, the date specific training or formal supervision took place and the date the person actually took up employment at the home. This is especially important with regard to POVA First and CRB clearances. For any person that has regular contact with residents, excluding family or friends, but including potential staff/volunteers, at minimum a satisfactory POVA first must be obtained and the person must be directly supervised prior to the full CRB clearance being received. As part of the recruitment process, all prospective, shortlisted employees visit the home and spend time with residents who are then asked if they would like that person to work at the home and support them. Their responses are taken into account when considering a suitable person to appoint. The AQAA confirmed that where ever possible, residents are included on the interview panel and details of the interview are recorded. All newly appointed staff are employed initially on a three month probationary period that can be extended if required. The AQAA also stated that staff are recruited from different faiths and have varied cultures as well as different skills , knowledge and experience in order to meet the individual needs and wishes of each resident. From discussion with the registered manager, it is understood that all newly appointed Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: support staff undertake the Learning Disability Award Framework (LDAF) induction training programme to ensure they are provided with the basic skills and knowledge to provide a good service. All staff receive a variety of mandatory training that includes health and safety training, protection of adults training and medication training. Further training in specialised areas is arranged to address the individual needs of the people living at the home and for one support worker this recently included, Alzheimers and dementia training, risk assessment, advocacy, Mental Capacity Act training, and positive behaviour support. A three day Deprivation of Liberty Safeguards training course has been arranged to take place for the full staff team in the near future. Whilst it is clear that staff training is taking place and certificates were available to evidence this achievement, it is recommended that a staff training matrix be developed. This would give a clear overview of the training already completed by each member of staff, identify further training needs and highlight when refresher training is due. There are good supervision arrangements in place. It is understood that all staff receive formal documented supervision at least six times a year. In the main, from the three staff files evidenced, records were available to confirm that formal supervision was taking place about every two months. This was also confirmed by the support worker spoken with who also said that she had been, Very well supported since she commenced employment at the home. However at the time of the site visit, for another support worker, a supervision record could not be evidenced since January 2009. Whilst there is no suggestion that formal supervision had not taken place, it is important the supervision records are kept secure and available. It was also noted that on some occasions the supervision record had not been signed and dated by the supervisor or supervisee. Again this is important to confirm agreement of the topics discussed and the outcomes. In addition, formal appraisals take place annually, this includes a self appraisal and self development plans. Through one to one supervision arrangements and annual appraisals, training needs are addressed and staff are given opportunity to put forward their own training and development suggestions. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and quality monitoring arrangements help to ensure that good standards are maintained. Staff training, policies and good practice promote the health and safety of those living and working at the home. Evidence: The homeowner/registered manager has many years experience in the care and support of people with a learning disability and is suitably qualified to provide a good service. The registered manager and second homeowner have both successfully achieved the Registered Managers Award, a qualification that all managers of care homes are expected to achieve to ensure they have the skills to manage the care home in the best interests of the people living there. Staff spoken with said that they felt well supported by the management team who were approachable and ran the home well. The registered manager also ensures that he regularly undertakes refresher training and additional new training to make sure that he is familiar with current best practice in order to guide and advise the staff team. Since the last key inspection, a House Leader has been appointed to over see both homes. This person is currently undertaking an NVQ Level 4 in care and it is hoped that once this is Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: completed along with some additional management training, the House Leader will undertake greater responsibilities within the two homes. There is a weekly meeting arranged between the homeowners and the House Leader to discuss any new developments as well as day to day topics. One member of staff told us on a Care Quality Commission (CQC) survey, Its a shame we only have two homes, I wish we were a bigger organisation then I know a lot of people would get proper care and I really like my job, Im going to be here for a long time. Ways to gain information regarding quality assurance about the home and whether the support offered is meeting residents needs, is considered important. Various quality assurance systems are in place including, questionnaires for residents, their family/friends and the staff team. Residents also have opportunity to make their views known at resident meetings. Regular staff meetings also take place. Good minutes are kept of all meetings held. The outcome of the questionnaires are collated and a copy of the report is passed to a relative of a resident living at the home. This relative then makes comments and suggestions before the outcome is discussed with residents, staff and other interested people. It is understood that the second homeowner contacts family members living abroad by e-mail with regular updates, this provides a further opportunity for relatives to voice their views and opinions of the service being provided. Residents however have a very good, trusting relationship with each other and the people who work at the home and daily informal verbal discussion forms a strong part of the quality monitoring systems within the home. A business plan for the home is available and a questionnaire, Planning for the Future has been distributed to the staff team asking for suggestions for improvement. Staff are encouraged to be actively involved in the planning and delivery of the service provided and there is a very open and supportive relationship between the homeowner and the staff team. Residents are also encouraged to participate in the business plan and parents and families are to be invited along to a meeting. The aim is to involve as many people as possible who have an interest in the home, to have their say as to what they see as important for the future development of the home and the service provided to residents. The home has also successfully maintained the Investors in People award (an external quality assurance monitoring organisation) demonstrating that there is a commitment to have the quality of care provided, assessed both internally and externally. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: Records relating to health and safety were seen. Records showed that equipment is regularly serviced and a number of up to date certificates were evidenced that included, fire safety equipment, an electrical installation certificate and small electrical equipment is also inspected on an annual basis. Staff training is in place regarding all the key elements of health and safety training that is mandatory for all staff. Environmental risk assessments are undertaken when a risk has been identified in order to minimise or eliminate the risk and fire risk assessments are in place. Fire safety forms part of the initial induction training programme and fire drills are undertaken on a regular basis. All these checks, along side the training that staff receive, help to protect people living at the home, staff and visitors. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 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 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 9 When ever a specific risk is identified, a formal risk assessment should be in place even if the risk is minimal. This would provide clear guidance to the staff team should an incident occur in order to protect the resident. The medication administration record should always be completed immediately after the medication has been administered. This would then provide an accurate record of the medication administered or alternatively not given or refused, and provide a clear audit trail of medication into the home, administered to residents and returned to the chemist for disposal. There should be a clear record maintained of the date an applicant is offered employment at the home and the date the applicant actually takes up their employment at the home. The date any training or supervision that takes place prior to commencement of actual employment should also be recorded. This would provide a clear chronological order of events and help to confirm that the applicant was not in regular unsupervised contact with residents until the full clearances and references had been received. It is recommended that a staff training matrix be developed Page 32 of 34 2 20 3 34 4 35 Care Homes for Adults (18-65 years) 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 to provide an overview of the training already completed by each member of staff and identify future training needs. 5 36 It is recommended that all supervision notes are kept secure and available and that the individual supervision record is signed and dated by the supervisor and supervisee. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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