Care Home: The Avenue

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What the care home does well Comments included in surveys received from people living in the home told us: `The staff are friendly and the home is clean.` `I like the three new staffmembers.` `Nice staff who treat me well and are very caring.` The three newer staff member told us throught he staff surveys: `I have worked in many different homes and feel that the Avenue is definately the best home out of them.` `As a relief worker I have found the home to be one of the nicest places I have worked.` Surveys from health care professionals included comments such as: `Well trained staff.` `well organised and creative.` `flexible and caring atmosphere.` Care plans provide clear and detailed information about how the needs of the people living in the home should be met. They show how people are encouraged to be independent and how all areas of peoples` lifestyles are maintained. People living in the home are supported with their health care needs. Accessible information about their health helps them to be informed and involved in the planning of their care. People living in the home are supported with their personal development, in accessing the community through various work, leisure and social activities. They have made choices about being involved with local issues through appropriate networks and partnership boards. What has improved since the last inspection? Individual care plans reflect the `best interests` of the peoples` living in the home taking into consideration mental capacity issues. Staff have been trained in understanding issues of consent and this had helped in reviewing peoples` consent forms relating to medication, money saving, healthy eating and saving for holidays. At the Random Inspection in February 2010 we found a requirement had been met for an individual living in the home to have their medication stored securely. Individual lockable medication storage cabinets had been installed in the bedrooms of all the people living in the home to ensure medication was kept safe and that people were protected. We know staff are now reporting concerns they may have about the people living in the home as we have been informed through written notifications, and have been told verbally. Staff and the directors have been trained and are putting their knowledge and understanding into practice and are following policies and procedures to ensure the people living in the home are protected from abuse. The recording of all financial transactions of the people living in the home had improved with new policies and procedures that were clear and helped the tracking process to ensure peoples` financial records could be monitored robustly. Records were being kept of the property and belongings of the people living in the home. These were looked at in depth at the random inspection in February 2010 and found to have more robust measures in place to ensure the finances of the people living in the home were being safeguarded. At the Random Inspection in February, we saw there had been improvements in the way the home was being run. Staff were no longer using their loyalty cards to purchase items for the people living in the home. Staff were being supervised on a regular basis covering all aspects of their role including safeguarding issues to ensure the people living in the home were protected and staffs` work performance was monitored. What the care home could do better: There are no requirements. Key inspection report Care homes for adults (18-65 years) Name: Address: The Avenue 6 The Avenue Keynsham Bath & N E Somerset BS31 2BU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Webb     Date: 2 6 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 34 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 34 Information about the care home Name of care home: Address: The Avenue 6 The Avenue Keynsham Bath & N E Somerset BS31 2BU 01179864700 01179862524 helen.hill@sovision.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Keynsham & District Mencap Family Home Name of registered manager (if applicable) Mrs Helen Barbara Hill Type of registration: Number of places registered: care home 8 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 8 The registered person may provide the following category of service only: Care home only - code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home The Avenue is a large four storey, semi-detached property situated in Keynsham. It provides accommodation for seven people between the ages of 18 and 64 years of age who have a learning disability. There are some people who are over 64 years who have lived at the home for many years. The house has a basement flat that provides accommodation by way of a selfcontained living area. This comprises of two bedrooms for two people, a bathroom and a small kitchen. The first and second floor of the property provide accommodation for Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 8 0 1 0 5 2 0 0 9 Brief description of the care home six people. A new wet room, containing a fully accessible toilet and shower, has been installed to meet peoples changing needs. There is also a new staff sleeping-in room and a new office. A basement has been provided for storage space for old records and other items. The home is within easy access of local amenities that include a leisure centre, shops and park. There are accessible transport routes to Bath and Bristol by both bus and train. 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 was an unannounced Key Inspection carried out over one day. The last Key Inspection was completed on 27th October 2009 following up a previous poor rating of the home. We had planned to inspect the service within six months of the last inspection as the outcome had been poor for a second time. We met with the Avenues board on 18th December 2009 and were told of the action that had been taken to meet the requirements issued at the Key Inspection of 27th October. The Directors requested a review of the rating of the home that was given at this inspection. The outcome of this review was that the rating remained unchanged and we were sent an improvement plan. We carried out a Random Inspection on 25th February 2010 to assess whether specific requirements had been met. We found these requirements had been met. Care Homes for Adults (18-65 years) Page 6 of 34 The pre inspection planning involved reviewing the previous Key Inspection report, the improvement plan and the random inspection report. We looked at the service history that details all other contact we have had with or about the home. We spoke with the Registered Manager, two staff and a relief worker. We also spoke with three people who live in the home. We received surveys from the people living in the home and from health care professionals. The findings of these surveys have been included in this report. We gathered additional information by looking at a number of records such as care plans, risk assessments, complaints, medication administration, staffing and health and safety. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? Individual care plans reflect the best interests of the peoples living in the home taking into consideration mental capacity issues. Staff have been trained in understanding issues of consent and this had helped in reviewing peoples consent forms relating to medication, money saving, healthy eating and saving for holidays. At the Random Inspection in February 2010 we found a requirement had been met for an individual living in the home to have their medication stored securely. Individual lockable medication storage cabinets had been installed in the bedrooms of all the people living in the home to ensure medication was kept safe and that people were protected. We know staff are now reporting concerns they may have about the people living in the home as we have been informed through written notifications, and have been told verbally. Staff and the directors have been trained and are putting their knowledge and understanding into practice and are following policies and procedures to ensure the people living in the home are protected from abuse. The recording of all financial transactions of the people living in the home had improved with new policies and procedures that were clear and helped the tracking Care Homes for Adults (18-65 years) Page 8 of 34 process to ensure peoples financial records could be monitored robustly. Records were being kept of the property and belongings of the people living in the home. These were looked at in depth at the random inspection in February 2010 and found to have more robust measures in place to ensure the finances of the people living in the home were being safeguarded. At the Random Inspection in February, we saw there had been improvements in the way the home was being run. Staff were no longer using their loyalty cards to purchase items for the people living in the home. Staff were being supervised on a regular basis covering all aspects of their role including safeguarding issues to ensure the people living in the home were protected and staffs work performance was monitored. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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. People wanting to move to the home can be confident they will be supported as their needs are assessed before moving in. People living in the home are provided with a up to date written statement of terms and conditions. Evidence: We did not look at the Statement of Purpose or the Service User Guide as the manager told us this these documents were to be reviewed fully. The people living in the home have asked for a DVD to be made of their home. We were told by the manager that a learning disability network media group has been asked to act on this and this will be additional to a new pictorial Service User Guide. There have been no new admissions to the home since the last key inspection of October 2009, and the random inspection of February 2010. There are currently no vacancies. All eight people are funded by the local authority and had been previously Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: assessed before moving to the home to ensure their needs could be met. Three surveys received from healthcare professionals told us the care services assessment arrangements always ensure that accurate information is gathered and that the right service is planned for people. Two further surveys told us this usually happens. We saw copies of individual license agreements between the people living in the home, the care service and the housing association who owns the property. We saw an up to date annual review of accomodation charges in the main care files of the people living in the home. We received completed surveys from all the people living in the home before the inspection took place. These were completed with the help of day service staff. Comments included Nice place to live , I am well looked after and we have fun and It (the home) makes me happy. These views were also confirmed by people spoken with who live in the home. Many positive comments were made through staff surveys we received and from speaking to staff that told us that the Avenue provides a caring and homely atmosphere. We received five completed surveys from health care professionals involved in the care and support of the people living inthe home. Comments included Provides a supportive environment and encourages and enables clients to live their life to their full potential. 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 in the home benefit from a person centred approach to care planning. Clear and detailed information is provided about how people wish to be supported reflecting their best interests. People living in the home are supported in making decisions and choices about their lifestyles that reflect their individual capacity to consent. People living in the home are supported safely to take risks to help enable them to live as independently as possible. Evidence: We read in detail the care files of three people living in the home and sampled files of others as part of the case tracking process. We spoke to people living in the home and staff to find out how people were supported. This helped to confirm the individual care planning we saw that showed how the needs of the people living in the home were met. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: From the 6 surveys we received from staff, we were told staff are always given up to date information about the needs of the people living in the home. Care files had information covering all areas of peoples lives, including their personal care, their social lives, and how their independence was maintained. Care planning was presented in person centred way and showed the involvement of the people living in the home through photographs and pictorial information. An Essential lifestyle approach showed relevant information had been collected in providing a full and detailed picture of how people wanted to be supported with their needs. The care of the people living in the home had been reviewed on a regular basis. This included annual care reviews, monthly reviews of peoples needs by keyworker, and general monitoring through staff meetings. From assessing the care planning process we saw a requirement had been met for individual care plans to be developed with the people living in the home that reflected their best interests in line with their assessed mental capacity. Information showed people living in the home had been involved in making decisions and if support was required this had been recorded. A requirement had been met for the consent forms of the people living in the home relating to medication, money saving, healthy eating and saving for holidays to be reviewed. We saw from training records that all staff had attended training in the Mental Capacity Act and Deprivation of Liberty Safeguards that was delivered to the staff in relation to the people living in the home. We saw individual records relating to peoples capacity to consent. These were written in a person centred way and set a framework in how people made decisions. The framework included an assessment of their decision making, an explanation of what people were consenting to. Individual areas covered personal care, bus training, healthy eating, first aid, and medication. They had been signed by the people living in the home and dated. Individual diairies contained on going daily reports of the activities people had attended, and the individual care they had been offered. It was evident people living in the home had been supported with decision making, and to express their views, through different forums. Meetings had been facilitated by an external advocacy service who also helped the people to complete questionnaires Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: about their care so that the homes staff were not involved. We saw the manager speaking with an individual asking if they wanted to go on a day trip with a social club. The individual told the manager they didnt want to go and we saw this decison was respected by the manager. However she had concerns that the individual may change their mind when they saw that other people living in the home were going. The manager said she would ask the individual again at a later date, but was clear that if they chose again not to go their decision would be respected. We saw records of regular meetings held with the a member of the management committee where people can raise any issues, concerns or topics of interest. It was evident that people living in the home have continued to be supported in attending local forums so that they are involved in decision making about local issues that concern them. These include attending a local learning disability network forum to talk about how improvements can be made to the community. An individual from the home represents the local network in improving road safety in the local community. Another individual is on the Partnership board for the local council and another represents the local network group and attends town council planning meetings to look at accessibility issues and future housing for supported and independent living. Recently people living in the home have joined another advocacy group called People First Bath. To the question Do you make decisions about what you do each day all but one person answered Always. One person was unable to answer the question. We saw individual personal risk assessments for each person reflecting risks and action taken to minimise risks. These had been reviewed and contained up to date information. They included road safety, out and about in the community, and accessing home alone for three people. We saw manual handling risk assessments that set out the action to take in supporting people safely and with specific equipment to be used. 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. People living in the home have various opportunities to be involved in paid work, projects, leisure and social activities. They are supported to keep in touch with their families and friends. People living in the home are involved in the routines and are offered individual, varied and healthy diets. Evidence: People living in the home attend various college courses and day service placements. Two people are in paid employment and have been involved in making a DVD about employment. We saw that people living in the home had attended two conferences promoting the rights of adults with learning disabilities. Some people were also being trained to be a Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: trainer , through a local network group, to talk to different groups about challenging behaviour. We spoke to people about their lifestyle and the routines and activities they were involved in. The information they gave us was confirmed through daily diaries that showed individuals details about their routines such as getting breakfast, vacuuming, polishing, collecting newspapers, cooking, and for two people, shopping independently. We saw individual training programmes working towards independence that included food preparation, kitchen and bathroom cleaning programme, and money saving. All had been reviewed and contained up to date information. We saw photographs of people carrying out various daily living skills that were used as prompts. One individual living in the home manages their own budget. They are supported individually and buy into activitites outside of the home. They told us they liked cooking and keep fit and about their routines such as cleaning their room and about their shopping in Keynsham. They told us they liked living at the Avenue. We met the person who they had employed to support them with their prefered activities and were told they were going to cook a meal. We spoke to another individual who told us they enjoyed listening to music. They told us about a new social club they belonged to where they were meeting new friends. They told us about the activities they did that included going to church, swimming, and playing snooker. We saw that an individual had been supported with 1:1 sessions of gym and fitness with a local authority gym instructor, and they were looking forward to going to the local gym in May. It was evident the staff team has continued to support people living in the home with their prefered activities. We saw from care plans, timetables, and individual diairies that people were involved in a wide range of activities such as horseriding, shopping, going for meals and to the cinema, and to local social clubs. The manager told us that people living in the home had also extended their social circles by attending a new drop in centre outside of Keynsham. We saw from photograghs that the people living in the home had been involved in a Sports Relief sponsored mile walk and various trips out. People had also been involved in a project through Bath University about their experiences of social work. People living in the home had made plans to go on holiday. Some were going with a Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: social club to stay in a caravan on the Isle of Wight and to Wales. The manager said that people had requested to go on a cruise together and this was being planned for later in the year. Completed surveys received from all the people living in the home answered that they can do what they want to during the day, in the evening, and at the weekend. Individual comments included They let me have my own money to do my shopping in Keynsham, They do trips, and Its boring just staying at the home but we get taken out often. All five surveys received from health care professionals told us the care service always supports people to live the life they choose wherever possible. We saw that people living in the home were supported to keep in touch with their families and friends. Diaries showed when friends have been invited to the home for a meal and when people have had visits from their families, and stayed with them. People living in the home are involved in helping cook meals for everyone. We saw menus that showed people made individual choices about the food they wanted. Choices made were of a wide range of healthy and balanced diets. Individual written consent forms about supporting people with eating healthly diets had been reviewed. These showed how staff had involved people in understanding their decison and agreement in being involved with healthy eating. 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. People living in the home are supported in the way they want with their personal support. Their health needs are met and monitored well. People are supported to take their medication in a safe way. Evidence: The care plans of the people living in the home showed staff how they should be supporting people with their personal support needs and their preferences. Daily diaries recorded peoples daily routines and this confirmed their care plans were being followed. All the surveys we received from the people living in the home told us that the staff and manager always treat them well. We spoke with a relief member of staff who told us that the people living in the home were treated respectfully. All five surveys received from health care professionals told us the care service always respects peoples privacy and dignity. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: People living in the home are registered with the local doctors practice. We saw detailed information recorded about how the individual physical and health care needs of the people living in the home were being met. Health Action plans included accessible information for people about their health including health awareness, lifestyle plans, keeping fit and healthy. Health Action plans had records of when people had visited various health care specialists including optician and dentist. Records showed that staff had monitored peoples individual health care needs and if they had attended appointments regarding their health and emotional well being. We saw specialist services were arranged when required including orthotic support, hydrotherapy, and physiotherapy. We saw from records a chiropodist visited the people living in the home on a regular basis. All five surveys returned from healthcare professionals tolds us peoples social and health care needs are always properly monitored, reviewed, and met by the care service. Three surveys received from health care professionals told us the care service always seeks advice and acts on it to meet peoples social and health care needs and improve their well being. Two surveys responded usually. A comment included in a survey told us Very willing to cooperate with proposed treatment plans and support patient attendance for treatment. We were shown how people were assisted with their medication and saw they were supported through a monitored dosage system. Care plans and individual medication profiles showed staff how people should be supported with taking their medication safely. We saw records of how medication was received in the home, stock control systems and when people had been given their medication. Risk assessments for two people who self medicate had been reviewed to show people were being supported safely in taking their own medication. At a Random Inspection in February 2010 we found a requirement had been met for an individual living in the home to have their medication stored securely. Individual lockable medication storage cabinets had been installed in the bedrooms of all the people living in the home and we saw this in three peoples bedrooms. All six staff surveys told us they are given enough knowledge about healthcare and medication. 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. People living in the home can be confident that their concerns and complaints will be listened to and acted on. People living in the home are protected from abuse through a trained staff team. There is an improved understanding of how people should be protected from abuse with staff following up allegations. The finances of the people living in the home are protected thorugh robust systems. Evidence: There is a complaints policy and procedure with a guide to how it should be used. The manager told us she is making enquires about improving the accessibility of the current complaints procedure for the people living in the home. We saw the complaints log. Since the last key inspection there have been three complaints. All of these were complaints made by some of the people living in the home about each other. We had been informed by the manager previously about these complaints. The records showed the action taken and the outcome of the complaints. The improvement plan told us complaints were raised as an agenda item at every residents and staff meeting. This was confirmed by the records we saw of these Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: meetings. Surveys received from six people living in the home told us that they knew who to speak to if they are unhappy, one person said they were happy, while one person did not answer the question. Five people answered that they knew how to make a complaint, while two people answered No and another that they didnt understand the question. This is suprising as we saw from regular meetings the people have had over the past year that they have been informed about how to make a complaint with appropraite accessible information to support a better understanding. Also people have made complaints about each other. It was evident that some people did not understand the question. Surveys received from six people living in the home told us that the staff and manager always listen and act on what they say, while one person answered usually and another didnt understand the question. We have been told about incidents, accidents, changes in peoples behaviours and any thing that affects the well being of the people living in the home. We saw records of these had been kept and action taken to support people. Individual disability distress assessment tools provided details of when people may become distressed and what action can be taken to support and minimise behaviours. A requirement has been met for an understanding of every aspect of how to safeguard vulnerable people and clarified with every person who works in the home or is involved with running it. This had been assessed as partially met at the random inspection of 25th February 2010. We noted then, that staff were reporting concerns they had about the people living in the home, but we were unable to speak to the manager, and follow up the knowledge and understanding of newer relief staff of how to safeguard vulnerable people. At this inspection we spoke to both existing and relief staff. They were both clear about action to take in the event of a disclosure made by people living in the home. The existing staff member was able to confirm the same action as set out in the policy and procedure. Staff surveys received confirmed staff knew what to do if someone had concerns about the home. We were told by the manager that the role of the keyworker included ensuring that Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: they knew how to safeguard people by following safeguarding protocol and policies. Since the last Key inspection the manager has followed policies and procedures in safeguarding the people living in the home. She has reported everything that she has perceived may be safeguarding concerns to both the local authority and us. We saw a safeguarding action notice displayed in the office showing staff relevant contact details. We saw records of six safeguarding referals made to the local authority with the outcome and action taken. Following some of these we saw safeguarding plans that had been put in place by the local authority for some of the people. Staff supervsion records showed that safeguarding was a key topic for discussion. All the existing staff and directors had attended safeguarding training. The improvement plan told us that all employees and the directors would continue to be updated every year with safeguarding training. A recommendation had been met for the bullying policy to include reporting to the local authority safeguarding and us. A comment from a survey received by an individual living in the home told us Looks after me, makes sure I am safe. A comment from a staff survey told us From lessons learnt I will inform the manager of any concerns I have regarding the staff and residents and I will encourage the residents to do the same. We take on board any comments made. We saw the recording of all financial transactions of the people living in the home had improved. We met a book keeper who checked peoples financial records monthly and they confirmed new policies and procedures were clear and helped the tracking process to ensure peoples financial records could be monitored robustly. These were looked at in depth at the random inspection in February 2010 and found to have more robust measures in place to ensure the finances of the people living in the home were being safeguarded. Care Homes for Adults (18-65 years) Page 23 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. People living in the home are provided with a clean, comfortable, safe and well maintained home to live in that has been adapted to support individual needs. Evidence: The Avenue is a large, four storey semi detached property in Keynsham. There are a few car parking spaces at the front and a large garden with mature shrubs and a patio area at the back. At the front entrance a canopy has been provided for people to be able to sit outside with bench and chairs. The home blends in well with the local community and is in a quiet location. People living in the home can get to Keynsham high street easily, to use the local amenities. People benefit from living near easily accessible public forms of transport near by to Bath, Bristol and surrounding areas. The home was clean, tidy, light and airy with the furnishings and fittings of a good quality. All areas of the home had been tastefully decorated and there were many photographs of the people living in the home that were displayed, personalising the home. Peoples bedrooms had been decorated individually and showed their personal Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: interests and preferences had been respected. Some peoples bedrooms had been decorated since the last inspection. We spoke to an individual living in the home who told us their room was going to be decorated. They showed us a new chair and had made choices about the decoration they wanted. They told us they had a new television and currently use the email and internet facility from the office. The manager told us they are looking into an internet facility for their own room. There are communal areas for people to relax in and we saw people sitting in the lounge, the dining area and going into their rooms, looking very relaxed and comfortable in their environment. The manager told us they are waiting for thermostats and self closing taps to be fixed as there have been a few accidents when people have not turned off taps and rooms have been flooded. The home is fully accessible to all the people living in the home. A ground floor extension has been built to one side of the property and this has provided the home with a wet room, containing a fully accessible toilet and shower. An external passenger lift is situated by the main entrance for anyone who may be unable to use the steps. A stair lift has been installed to the first floor for those who may need support. The existing utility room has been relocated with new laundry equipment for people so that the two people who live more independently are not disturbed by people going through their kitchen. This shows peoples privacy was being respected. Surveys received from the people living in the home told us the home is alwaysfresh and clean. Comments from surveys received from health care professionals included Supports individuals and allows people to live independent lives in a comfortable environment. Care Homes for Adults (18-65 years) Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of the people living in the home are met by a consistent staff team. The best interests of the people living in the home are protected through better work practice by staff. Staffing levels to support the people living in the home with their needs are being reviewed so that existing staff do not work exessive hours. People benefit from thorough recruitment checks on new staff to ensure they are safe to work in the home. People benefit from a staff team who are supervised regularly, with their work performance monitored. Evidence: We spoke to a relief staff member who told us about their previous and existing experiences in working with people with learning disabilities. They confirmed the recruitment process of completing an application, submitting two references, a Criminal Records Bureau (CRB) check and an interview by the manager. They had been given an induction that provided them with clear information and structure to help them in their role. They said they would like to be employed at the Avenue as a Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: permanent staff member but that this was not possible due to the revised policy of not recruiting staff who were related to existing staff. All six staff surveys told us appropriate recruitment checks were made before they started work at the home. All six staff surveys told us induction covered everything they needed to know to do the job when they started working at the home and that staff had been given training that was relevant to their role and helped them understand and meet the individual needs of the people. We spoke to an existing staff member who told us there was a better focus for staff, that they did not feel so pressurised, with all the staff working well together. They told us they were registered to complete a National Vocational Qualification (NVQ). This is an area that has been recognised for all staff to complete a NVQ. We saw written information about the daily duties staff undertook. Staff signed when tasks had been completed helping to monitor their work. It was evident that staff had been working exessive hours. One staff member said it will be good to employ more staff so that they can work less hours. They said they were rostered to work 48 hours a week. This is the working time limit as directed by working time regulations. We were told the committee have met to review staffing hours so that new staff can be recruited. We were told by the manager that the needs of the people using the service need to be looked at when recruiting staff and that male staff are needed. This was also confirmed by a staff member spoken with. People living in the home have started accessing different social clubs in different areas. The manager is aware more part time staff may need to be employed providing more flexibility in providing the individual support people need. We looked at four staff files. These included job description, training certificates application, CRB, references and overall training records. We were told that new contracts for existing staff were in the process of being completed. Staff training records showed that staff had completed recent training in infection control, safeguarding, the Mental Capacity Act and Deprivation of Liberty Safeguards and it was evident that staff are putting their knowledge into practice to help ensure the best interests of the people living in the home. We saw mandatory training was up to date with records showing when updates were needed. This helped to monitor staff are provided with refresher training in health and safety, fire training, first aid and food hygiene. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: We saw the improvement plan had identified the importance of quality external training for all staff on learning disablity specific courses to be attended. Supervision records showed all aspects of staffs work and responsibilities had been discussed at each supervision meeting. A review of their work performance was also included as part of the discussion. Supervision had been carried out by the manager on a monthly basis. A member of staff confirmed she received regular formal supervision but that the manager was also available in advising informally. We were told the directors had reviewed previous appraisal formats and were in the process of making enquiries about using a more appropriate format. All six staff responded through the staff surveys that the manager regularly gives them enough support and meets to discuss how they are working. A comment made in a survey from an individual health care professional told us Understanding and well trained staff. Care Homes for Adults (18-65 years) Page 28 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. People living in the home benefit from improvements that have been made with the home being run in their best interests. Policies and procedures are being followed and record keeping safeguards peoples rights and best interests. The views of the people living in the home, and those who have an interest in their care and support, are sought to help review practice. People living in the home benefit from their health and safety being protected. Evidence: Since the last key inspection, the manager Mrs Hill has attended and passed a three day training course on supervisory skills through the Institute of Leadership and Management. She is due to attend a five day course for first line managers in June 2010. This management training was included in an improvement plan as part of a developmental action plan for Mrs Hill following previous concerns about the conduct and management of the home. Mrs Hill showed us her pass rate for the supervisory skills which was of a high standard. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: It was evident Mrs Hill and the directors have taken on board the serious concerns we had at the last two key inspections. All the requirements had been met and these have been refered to in the relevant text of this report. We have received several improvement plans in relation to the two previous Key inspections. The most recent plan received March 2010 provided us with more detailed information about how improvements were to be made and how requirements were to be met. This has been referred to in the text of this report where relevant. Mrs Hill told us changes need to be made and we have to learn from our mistakes but also celebrate the good points. Since the inspection we have been sent completed questionnaires that were given to people living in the home, 15 families and 9 health care professionals by an external advocacy service. We spoke to the manager of the advocacy service during the inspection as the results had only just been obtained and were told the feedback from the questionnaires was positive, and that the only issue for visitors was the parking at the home. An audit of the home is also planned and has been commissioned for Bath People First to carry this out. We saw at the random inspection of February 2010 that record keeping had improved. Requirements had been met for inventories to be updated, and financial systems to be improved. We saw fire records showing routine fire safety checks on equipment had been maintained on a regular basis. Fire drills and fire training had been recorded monthly. We found there have been improvements in the way the home is being run. We saw at the random inspection that staff are no longer using their loyalty cards to purchase items, such as clothing, for the people living at the home. We recognised that this practice may have been to save money for people living in the home, but that it also implied people were not making choices for themselves. At this inspection we saw evidence that showed the home was being run in the best interests of the people living there. At the random inspection we saw new specific policies and procedures in place relating to the recording of expenditure, personal finances and property of the people living at the home and that these were being followed by staff. We saw at this inspection that staff are now following safeguarding policies and procedures. Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: We have received fuller monthly reports in respect of the monitoring of the home. These now include a summary that highlights specific areas of change, concern, complaint and safeguarding. A management summary of the property and any planned or outstanding maintenance issues are recorded and show they have been monitored. It was good to see at this inspection that the organisation has recognised previous serious failings and have taken the right action. We will continue to monitor the service closely to ensure that improvement to the lives of the people living in the home is maintained. Care Homes for Adults (18-65 years) Page 31 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 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 33 of 34 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). 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