Norwood - 60 Carlton Avenue

About the service

Norwood – 60 Carlton Avenue is a residential care home providing accommodation and personal care to up to 8 people with a learning disability and autistic people. At the time of our inspection there were 6 people using the service, 1 person who used the service was admitted to hospital at the time of our inspection.

People’s experience of using this service and what we found

Right Support: Staff understood people extremely well and there was a strong focus on promoting people’s independence and providing the maximum choice, which was fully embedded in the service. People were supported by an enthusiastic staff and management team who supported people to achieve their dreams and goals, with a focus on people’s abilities and skills. There was a strong focus on people to have an integral part in their local and wider community. Rooms and communal areas reflected what was important to people. People's personal space was respected and personalised with pictures, photos and items which were important to them. People were supported to take risks and live a fulfilled life. Support was tailored around people’s needs and was adjusted frequently to ensure it was meaningful and what people wanted to do. People’s needs were continuously reviewed and updated.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: The service considered diverse needs consistently in all aspects; this included care planning, risk assessing and the day to day support people received. The registered manager and provider led by example and guided staff on how to provide extremely individualised person-centred support with detailed care plans which provided clear guidance on people's wishes. Care plans were regularly updated and reviewed to ensure people’s individual needs were still reflected. There was a strong focus on working collaboratively with external stakeholders to ensure people’s needs were addressed and people and their relatives were heard when decisions about their care were made. The staff team showed a very good understanding of minimising risks and demonstrated their knowledge of safeguarding. The service worked continuously to explore new ways to engage people in communicating their needs. The staff and managers explored and introduced new tools to assist people to communicate their needs and wishes. The service supported people to have a well balanced culturally appropriate diet. Food and meal choices were respected and people were engaged and supported to make healthy culturally appropriate meal and food choices. Medicines were managed safely. Staff discussed the medicines clearly and explained the reason why the medicines were prescribed.

Right Culture: The service was led by a strong management team who embedded the values of a service led by the people and empowered people to be included in all aspects of the service. Staff felt they were extremely well supported by the management team. Staff supported people who had an in-depth understanding of good practice. Staff promoted people’s strengths and only offered support when people needed this to maintain and improve their independence. Care and support was innovative and the service was driven by people to achieve their own goals, dreams and aspirations. The culture within the service was to enhance peoples quality of live. There was clear evidence of working together with people to develop and improve the service and the quality of care provided. Concerns and complaints were responded to professionally, open and with transparency to make consistent improvements to the care people received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update - The last rating for this service was good (published 22 December 2017).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding and where the rating was more than 5 years old.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Norwood – 60 Carlton Avenue on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Norwood - 60 Carlton Avenue is registered to provide care and accommodation for up to eight people with learning disabilities. At the time of our inspection, there were seven people using the service.

At our last inspection on 13 and 19 November 2015 we found that the service met regulations and we rated the service as “good”.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Some people in the home had complex needs and were therefore unable to provide us with feedback. We therefore spent time observing interaction between people and staff. On the day of our inspection we observed that people were well cared for and appeared relaxed and comfortable in the presence of care staff. We saw positive engagement between staff and people using the service. Staff were respectful to people and showed a good understanding of each person’s needs and abilities.

There were systems in place to keep people safe. Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people’s safety and well-being.

Risk to people who used the service had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.

Medicines were managed safely and staff were appropriately trained. Appropriate infection control procedures were followed to minimise the risk of spreading infection. Accidents and incidents were documented and audited by the registered manager to find trends and prevent future incidents from happening.

On the day of the inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff we spoke with confirmed that there were sufficient numbers of staff to safely care for people.

People’s needs were assessed to ensure that the home was able to provide treatment or care appropriate to people’s needs. Staff were provided with ongoing training and regularly planned supervisions and appraisals ensured their performance was monitored and they were supported to care for people using the service and meet their assessed needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. The service operated within the principles of the Mental Capacity Act 2005 (MCA).

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

Suitable arrangements were in place to ensure that the nutritional needs of people were met. People's nutritional needs had been assessed and care workers were knowledgeable regarding the dietary needs of people.

The home had a varied activities programme and each person had their own activities timetable which was devised based on their individual interests. Activities included rebound therapy [this is also known as trampoline exercise therapy which uses trampolines to provide movement, therapeutic exercise and recreation], boccia [ball sport], sport sessions and dance sessions.

There was a management structure in place with a team of care staff, two assistant managers and the registered manager. Staff told us that the morale within the home was good and they worked well with one another. Staff spoke positively about working at the home. They told us management was approachable and the service had an open and transparent culture.

Staff were informed of changes occurring within the home through staff meetings and handover meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

There was a clear management structure in the home which provided clear lines of responsibility and accountability. Checks were carried out to monitor and improve the quality and safety of the home.

At the time of our inspection, the home was providing care for six people.

We used a number of different methods to help us understand the experiences of people who used the service, because people who used the service had complex needs which meant they were only able to communicate using key words, body language, gestures, facial expressions and objects of reference.

We observed the care provided and the interaction between staff and people who used the service. We also spoke with four care staff and the registered manager. We also read feedback from relatives.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service had support plans and risk assessments which helped to ensure their safety and welfare.

We found the home had safeguarding, whistle blowing and Deprivation of Liberty Safeguards (DoLS) policies and guidance in place. Training records showed staff had received training in safeguarding and DoLS. When speaking to them, they were able to provide examples of what constituted abuse and how they could identify abuse. They were aware of action to take and how to report allegations or incidents of abuse to the relevant authorities.

The Care Quality Commission (CQC) monitors the operation of DoLS which applies to care homes. While no applications have been submitted, appropriate policies and procedures were in place. When speaking with staff we found they had an understanding of the Mental Capacity Act (MCA) 2005 and the DoLS and how they applied to the people they were providing care and support to on a daily basis.

Is the service effective?

We found the home had taken steps to ensure that people were included and involved as much as possible in their care and support. We found staff used various methods of communication to engage and involve people who used the service as much as possible such as pictures, gestures, sign language, key objects and words.

We looked at four care plans and saw that people's needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. Risk assessments and behavioural support plans had been carried out. We found these were detailed and specific to each person and their needs.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff were trained in areas of relevance to their job roles and demonstrated knowledge of people's individual needs and requirements.

Is the service caring?

We found good feedback had been received about the home.

Feedback from one relative read 'Since my [relative] moved into Carlton Avenue'..I have been very impressed and happy with the level of support that they have received from all of the staff at the home. It is clear to me that the staff are committed to supporting the residents and all have a very caring nature, which is extremely important when working with people who are very vulnerable and cannot always express their needs'.

During the inspection, we saw people being treated with respect and dignity. We observed staff provided prompt assistance and were patient when supporting people. Staff communicated well with people and explained what they were doing and why. We observed people were given a choice by staff and asked what they wanted to do and staff adhered to their wishes.

Is the service responsive?

There was evidence that people's needs were monitored. We saw risk assessments and support plans had been regularly reviewed and updated when people's needs changed.

People's health and medical needs were assessed and we viewed records demonstrating that they were supported and had access to health and medical services when necessary.

Is the service well-led?

There were regular consultations and resident meetings with the people who used the service which gave them the opportunity to relay any issues or concerns they had and if they had any complaints they wished to make.

We also found regular staff meetings took place which ensured staff had the opportunity to communicate their views about the service and to discuss the care and support needs of people who used the service.

The home had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Checks had been conducted on all electrical equipment, and maintenance checks and service records were up to date.

People had plans in place that supported their individual care needs. However, we found that these were not reviewed in accordance with the providers own guidelines. Although we felt that people were safe and well cared for, the provider did not have arrangements to always ensure people's safety and welfare in foreseeable emergency situations. The home took into account people's views when arranging care and the decor of their rooms.

The provider had appropriate arrangements in place to ensure that people were safeguarded from the risk of abuse. The provider had policies and procedures in place to identify, assess and manage the risk to peoples general safety and welfare and sought the views of people and their relatives about the service they delivered.

Personal information was kept securely and was appropriate and relevant. The staff were aware of the need to keep personal data secure.

People told us they liked living at the home and relatives said they were always invited to attend people's care plan reviews.

We found that people were engaged in decisions about their care and people had regular reviews that they participated in. The service had developed communication methods so people could actively participate in discussions about their care and about the way in which the service was delivered.

We found that people had comprehensive care plans that identified their health care needs and where there was an identified change in people's needs,care plans were implemented and updated. We found that staff working with people had a good understanding of people's needs and had been appropriately trained to ensure people received effective care in accordance with their care plans.

We looked at the physical environment of the home and found it to be of a good standard. All rooms in the home were clean and appropriate hand gels and soaps around the home to prevent the spread infection. The home had a cleaning rota and domestic staff ensured the home was cleaned on a regular basis.