Care Home: The Avenue

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What the care home does well Each person who lives at the home has had their needs assessed to make sure the home can give them the care and support they need. All of the people have care plans which give information to staff about how to support them and meet their needs. Care is planned with the people in a way that they prefer and in a sensitive manner. The staff team at the home recognise the differing needs of the people who live there and make sure that they are aware of each person`s preferences. They treat the people as individuals and support them to live the life they choose as much as possible, so they will have new experiences and know that their opinions are valued. People who live at the home experience a variety of activities. This gives them choice, as well as building their self-esteem and confidence. The staff team make sure that the home is clean, warm and adequately furnished so the people who live at the home have a comfortable place to live. Staff support the people to use local services so they are part of the community. The staff make sure the people`s health care needs are met so they remain in good health. All of the people who live at the home have plans of care and risk assessments. This is so staff have the information they need to support each person and keep them safe. The home has procedures for staff for the administration and recording of medication, which is adhered to. This is to make sure the people who live at the home receive their medication when they need it and at the correct times. The home has procedures for dealing with complaints and protecting the people who live there from abuse. This means that the people who live at the home feel safe, know they can talk to the staff and that their views are listened to. What has improved since the last inspection? The environment continues to be improved, each persons bedroom has been decorated and refurbished. A new central heating boiler has also been installed. Service users continue to have opportunities to learn and use practical skills, through education and training. Staff have continued to support service users to become part of, and participate in, the local community. What the care home could do better: No requirements or recommendations were identified. Key inspection report Care homes for adults (18-65 years) Name: Address: The Avenue 72 Bates Avenue Cockerton Darlington County Durham DL3 0TU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jim Lamb     Date: 0 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Avenue 72 Bates Avenue Cockerton Darlington County Durham DL3 0TU 01325240452 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): john.leitch@tesco.net Mr John Michael Leitch,Miss Sharon Elizabeth Keelan Name of registered manager (if applicable) Miss Sharon Elizabeth Keelan Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability Code LD, maximum number of places: 3 Date of last inspection Brief description of the care home The Avenue is a small care home that provides personal care and accommodation for three adults who have learning disabilities. The Avenue is privately owned and is run by Mr John Leitch & Miss Sharon Keelan. The home is a semi-detached property, located in the Cockerton district of Darlington. Each person living at the home has their own bedroom. One bedroom has a private en-suite bathroom and the other two rooms Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 3 Brief description of the care home share a communal bathroom. Other living space in the house includes a large combined lounge and dining room and a kitchen diner. There is off-street car parking in front of the property and a small courtyard garden at the back. A fourth small bedroom upstairs is used as a staff office and out buildings provide storage and laundry facilities. At the time of the this key inspection the homes fees were £612 per week. Items not covered by these fees include hairdressing, personal toiletries and additional holidays. Up to date information about the homes fees and terms and conditions should be sought from the homes manager. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 3 stars. This means that the people who use the service experience excellent quality outcomes. How the inspection was carried out. Before the visit we looked at information we have received since the last visit, how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run, the providers view of how well they care for people, and the views of Care Homes for Adults (18-65 years) Page 6 of 26 people who use the service and their relatives, staff and other professionals. During the visit we talked with people who use the service, staff, and the manager, looked at information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for, looked around the building/parts of the building to make sure it was clean, safe and comfortable, and checked what improvements had been made since the last visit. We told the manager/provider what we found. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: No requirements or recommendations were identified. Care Homes for Adults (18-65 years) Page 8 of 26 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 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with enough information about the service to enable them to make an informed choice about whether this is where they want to live. Evidence: The homes Statement of Purpose and Service User Guide have been updated. These guides contained all of the information that is required to enable people to make an informed choice about where to live. Evidence was seen in service users files that service users or their representatives had signed a contract. The contracts were detailed and included a breakdown of the fees and who was responsible for paying them. Although admissions are rare, the manager confirmed that visits to prospective service users would take place before their admission to the home, to carry out an assessment of needs. All service users care plans contained assessments from the placing authority that were responsible for commissioning the service users care at the home. The home does not provide intermediate care Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is clear enough to ensure that staff have the information they need to meet the assessed needs of the service users. Evidence: There are comprehensive assessments in the service users care plans. There is also a comprehensive risk assessment of service users. There are advocacy arrangements, as well as family input to represent service users. Care plans are drawn up with service users. Plans are amended and reviewed every six months, or more frequently if needed. Monthly summaries of care are also completed. Staff were observed to demonstrate their skill in communication during the inspection, and were observed to discuss and explain routines and activities clearly with service users. Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: Service users are asked and allowed to make decisions affecting day-to-day choices and about the activities they participate in. Service users and staff discuss routines in the home, and service users have been able to make choices about decoration schemes, trips out, personal purchases and meals. There are regular house meetings between staff and service users. The way people communicate is also outlined within each persons care plan. These follow a standardised format. This includes an overview or summary of each persons needs, strengths and areas of risk. The plans are person centred, and they clearly relate specifically to each persons individual needs. Each of these has monitoring, evaluation and review notes written up. Closely linked to care planning arrangements are risk assessments. Areas of risk are documented within each persons care file, including assessments relating to activities out of the home and behaviours that may challenge the service. Current and additional control measures are documented, and this is then reviewed. There are systems in place that will ensure that the placement and the service users plans are reviewed at least annually, or more frequently if necessary. These involve the care managers and the service users representatives. The service users privacy and dignity are respected at all times. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are offered a good quality lifestyle, which includes social contact, and activities. Evidence: Individual care plans, photo dairy and daily care records provide good evidence that the persons interests and abilities are fully considered in planning their daily activities, which are planned with them individually. Some activities include attendance at college, clubs, cinema swimming, walks, and pub lunches for example. A photo dairy (person centred pictorial plans) produced by the individual and staff demonstrate the level and range of activities that they participate in. At the time of the inspection, people who use the service were engaged in a variety of different and appropriate activities in and out of the home, with staff support provided as necessary. In addition, daily care records show that they access a wide range of community resources with staff support, depending on their individual needs and Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: abilities. Each service user has at least two holidays each year, usually, Primrose Valley and a trip abroad. People who use the service are encouraged to maintain valued relationships with their families and friends, with staff support as necessary. One service user has no close family, however, his care manager visits him on a very regular basis, and he looks forward to these visits. People who use the service are supported and encouraged to eat healthily. They undertake shopping, planning for and preparing meals with assistance from staff. Nutritional needs and preferences are considered as part of the care planning process. People who use the service looked healthy and well nourished. The home has an ordinary, domestic kitchen, which they can access freely, to prepare drinks and snacks when they want them. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The promotion of health care is taken seriously, and service users have their personal needs fully met. Evidence: People using the service are given sensitive personal support by the staff to promote each individuals independence, dignity, privacy and choice. Each person has an individual assessment of his or her personal needs, and has a care/goal plan in place to meet those needs. Plans are person-centred, sensitive and thoughtful. They stress the strengths of the individual, and are positive in terms of seeking to develop the skills and abilities of the person. Privacy is given a high priority. Plans are reviewed every month, and amended as necessary, to reflect the progress made by the individual. Each person has his or her own Personal Health Information file. This contains professional health assessments, correspondence, records of contacts with health professionals. It demonstrated that all aspects of a persons physical and mental health are taken seriously and are properly met. Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: Medicines are ordered monthly, and these are delivered in blister packs. This is working well, and there are policies and procedures in place to minimise any risk of a medication error. The Medication Administration Records (MAR) was checked. This was found to completed properly, with no gaps. Senior staff do a weekly audit of the prescribed and non-prescribed (homely medicines) medications. Medicines are safely stored. All staff have had training on how to use the medication system. They have also had external Safe Handling of Medicines training. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints management is effective, and this results in the service users being protected from harm and abuse. Evidence: There is a complaints procedure. The procedure is written in a way that ensures service users fully understand its contents. The home keeps a record of complaints. The home has a Whistle Blowing policy, the Local Authorities Vulnerable Adults procedures, and a copy of the Department of Healths document, NO SECRETS. Staff are aware of these procedures and have easy access to them. Since the last inspection visit, there have been no complaints received. Safeguarding adults training is ongoing for all staff. Service users can deposit cash for safe keeping and records are kept of accounts. A sample of personal finances records was examined. Transactions were appropriately recorded. There was plenty of evidence of personal spending. Receipts are obtained for purchases and cross-reference to the transaction. Weekly checks of balances and cash are carried out. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and safe environment for those living there. Evidence: The home was clean, tidy, hygienic and there are no unpleasant odours. The layout and design of the home enables people to live together in a homely domestic environment. There is a pleasant garden area to the rear of the building that can easily be accessed from the dining area. Peoples bedrooms are attractively decorated and furnished. There are no shared bedrooms. Staff have supported people to personalise their bedrooms. One of the bedrooms visited has been fitted with an ensuite. The communal areas are well maintained attractively decorated areas. The kitchen was clean, tidy and hygienic. There is a combined lounge dinner which contains comfortable furniture and good quality furnishings. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough trained and experienced staff to meet the needs of the service users. Evidence: Staff levels on the day of the inspection met the agreed level for the number of service users. There are usually 2 carers between 8pm and 8am, and 1 waking night staff. The training needs of the staff are identified in supervision and appraisal sessions. The homes training programme meets the National Training Organisation requirements for the first six months. Staff receive at least three days paid training each year. All statutory training is ongoing and all of the staff team has completed NVQ level 2. The personnel records of two staff were examined. Both had completed application forms, the dates of employment were clear, making it Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: easy to follow a clear employment audit trail. The manager also completes an audit check list and this ensures that all the necessary checks have been completed prior to commencing employment. All had the required two work references, (crb) criminal record bureau check, documentary evidence of identity, induction and training and development information. All staff have an annual training matrix drawn up, this covers all mandatory training needs, and other core training needs, such as control of infection and Adult Protection. Individual staff members have his or her individual training needs analysis on their personal file. These have recently been revised to cover developmental as well as mandatory and core training. The manager said that, mental capacity and deprivation of liberty training has taken place. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is providing good leadership throughout the home, with staff demonstrating an awareness of their roles and responsibilities. Evidence: The manager had obtained relevant qualifications, including the Registered Managers Award. She had extensive experience and displayed the professional competence required to manage the home. There was evidence that the staff team worked hard to improve the lives of the people living at the home, and promote each persons independence. The manager and another staff member take on day-to-day responsibility for overseeing service users money. Staff signatures had been obtained for all money spent on behalf of service users and receipts had been obtained and attached to their financial balance sheets. Financial records showed evidence of regular audits. The manager acts as an appointee for the service users, and she confirmed that this was approved by the DSS. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: A quality assurance system had been developed, and an annual development/business plan is in place. All staff working at the home had received supervision at least six times during the last 12 months. Supervision sessions were used to provide staff with feedback on their performance, and training needs. A range of health and safety records were examined and found to be up to date. A tour of the premises identified no health and safety concerns. An audit of the homes fire records confirmed that the required fire prevention checks had been completed. For example, the homes emergency lighting and fire extinguishers had received monthly visual checks. An up to date fire risk assessment was in place. The homes accident records contained the required details. All water, gas and electrical appliances had been subject to the required safety checks. A range of workplace risk assessments had been completed. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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