CARE HOME ADULTS 18-65
Avalon Brea Farm St Buryan Penzance TR19 6JB Lead Inspector
Lowenna Harty Unannounced 21 July 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Avalon Address Brea Farm St Buryan Penzance TR19 6JB 01736 871876 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Amanda Gloria Nicholson Care Home 3 Category(ies) of Learning Disability (3) registration, with number of places Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: There are no conditions of registration additional to those stated above. Date of last inspection 4 January 2005 Brief Description of the Service: Avalon is a care home providing accommodation and personal care for up to three adults with a learning disability. It is owned and managed by the registered provider, Amanda Nicholson, who also lives at the home, with her husband. The house is a single storey building, set in its own, very extensive grounds, slightly off the main road. It is a working farm with horses, dogs and other animals. The home is situated outside the village of St. Buryan, several miles away from Penzance. The location is very rurual although there are buses to the main towns. Residents have their own bedrooms and a shared bathroom. There is ample communal space with a choice of lounges. The home provides good access for wheelchair users. No staff are employed to work at the home and the registered provider undertakes all the care and suppor to residents herself. Residents are expecteed to undertake a range of activities outside of the home and it is not suitable for people extensive personal care needs. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection as part of the home’s annual inspection programme, which took place on 21 July 2005. The inspection lasted for two and a half hours and consisted of the following activities: 1. Inspection of records, including assessment information and care plans 2. Discussion with the registered provider about life in the home 3. Inspection of the premises and 4. Meetings with both of the current residents, held in private, at their day placements, which are a few miles away from the home. Overall the home provides residents with a good standard of care in a safe and homely environment. They are encouraged to take part in a lot of different activities, to develop their skills and independence. One of the residents described life at the home as “top class” and “fantastic”. What the service does well:
Both the residents said that they are well cared for in the home. They are able to make choices about things that are important to them, like when they go to bed at night and they are able to go out on their own if they wish. They both have keys to the door of the house. They are able to keep in contact with their families and friends and do things they enjoy. One said that they like to help out with the animals on the farm. The other is looking forward to going horse racing. One has been encouraged in their sporting interests and was very successful in the Special Olympics, achieving gold medals. One of the residents knows all about their care plan and goes to reviews when they happen. Both of the residents go to work or a day centre during weekdays. They travel there on the bus and get on well with each other. Neither was able to think of anything that could be done better to improve their lives at the home. They are given enough support and help to care for themselves and have a comfortable, homely place to live. The house was clean and tidy even though the inspection was unannounced. Residents have plenty of space and they can spend time in their own rooms, the lounge, garden or conservatory when they are at home. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The registered provider needs to make sure that new residents are fully involved in providing information about themselves before they move into the home so that they can be fully involved in drawing up their own care plans. This needs to include information about risks, so that she can be sure that she is helping them to be safe, especially when they are out on their own. This information needs to be shared with the residents so that they can have a say about their lives and a chance to put their view across if they do not agree with what other people are saying about them. The registered provider would benefit from some training in the safe handling of medicines in case residents need to take medicines regularly in the future. The registered provider should draw up a more detailed business plan for the home and make sure that there is enough insurance cover in place to protect everyone in it. The home is now much safer but the registered provider should prepare a written risk assessment of the home to make sure that all risks are thought about and made as safe as possible for everyone in the home.
Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 There is inadequate assessment of prospective residents’ needs so that they can be sure that they will be fully and safely met. EVIDENCE: There are currently two residents in the home. One has lived there for many years and the registered provider is very aware of their needs and has enough information about them to make sure their needs are met. Assessment information relating to a more recently admitted resident lacked sufficient detail, particularly with regard to risks, for the registered provider to be able to draw up a full care plan and be sure that all risks are safely managed. There was no evidence that the resident has been involved in or consulted on the assessment process even though he has good communication skills, which he demonstrated during the course of the inspection. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 One resident is fully involved in drawing up their care plan and this needs to done for the other. Residents are supported and encouraged to make decisions about their lives and to take risks to develop their skills and independence although this needs to be improved for one of them. EVIDENCE: There was a lack of assessment information for one resident for the registered provider to draw up their care plan. The other has a detailed written care plan, which they have contributed to drawing up. They are fully involved in care plan reviews. Their care plan sets clear goals and considers their religious and cultural needs appropriately as well as all aspects of their health, personal care and social care needs. They are encouraged to develop their skills and independence. Residents have their own keys to the building and are able to go out in the community independently. Risks are taken into account although more detailed risk assessment information is needed in respect of one of the service users, as previously stated in this report. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Residents enjoy a wide range of activities that meet their needs. They regularly access the local community and are encouraged to maintain and develop positive relationships with people outside the home. EVIDENCE: Both of the residents are involved in a wide range of activities in and out of the home. During the week they attend day centres or work experience placements in the local community and were both out at these at the time of the inspection. Both expressed satisfaction with the activities they are provided with. They travel to their weekday placements by bus, together. The home has horses, dogs and other animals and residents are able to be involved in caring for them. They are assisted to access a local social club every week and visit their families and friends. The registered provider has transport to take them out and they are able to go out independently on bicycles or by bus if they choose. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 20 Residents are appropriately supported with regard to their personal care. There are safe systems for medicines in the home but the registered provider would benefit from training. EVIDENCE: The residents are mainly self-caring in respect of their personal care, washing dressing and grooming. Both appeared to be well groomed, appropriately and fashionably dressed. They have a shared bathroom, which is located conveniently to their bedrooms and offers them privacy. The registered provider offers support as necessary and this is reflected in their individual daily care records. There is a lockable storage facility for medicines and clear written policies and procedures. There are suitable records kept. Current residents do not take medicines on a regular basis but the registered provider should undertake training in the safe handling of medicines in case this situation changes. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Residents are well protected from abuse, neglect and self-harm EVIDENCE: Both residents have very good communication skills and stated that they feel safe and well cared for in the home. They have regular contact with friends, relatives and professional people from outside of the home so there is external monitoring of the care they receive. There is good communication between the home and their day placements, including involvement by day placement officers in their reviews. The registered provider has attended local multiagency training for the protection of vulnerable adults from abuse, has a copy of the local multi-agency vulnerable adult protection procedures and a written procedure specific to the home. This is based on the DH guidance “no secrets”. There is a written procedure for handling residents’ personal finances, which the registered provider has signed and dated, so that it can be kept under review. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The home’s environment is clean hygienic, homely and comfortable although further action is needed to improve residents’ safety. EVIDENCE: Residents live in a domestic, family home. There is ample communal space in addition to their individual bedrooms, which are large and well furnished. The home is well decorated, comfortably furnished and was clean and tidy throughout at the time of the unannounced inspection. Residents are able to personalise their rooms and keep them as they wish. They have adequate storage space to meet their needs. The registered provider has undertaken training in basic first aid, Health and Safety and basic food hygiene. The environmental officer has conducted an inspection of the premises, which was satisfactory. Electrical equipment and hardwiring tests are in the process of being completed. There is a fire safety risk assessment with records of drills and regular equipment tests. The registered provider has suitable information and equipment to prevent the spread of infection in the home. There is appropriate health and safety information but the registered provider needs to draw up an environmental risk assessment for the premises.
Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 Residents are protected by safe recruitment of volunteer staff. EVIDENCE: No staff are employed to work at the home as the registered provider undertakes all the care and support tasks necessary to meet the residents’ needs. The registered provider is in the process of recruiting volunteers to provide occasional assistance although this has not been necessary for the past year. She is taking up references and securing information required by regulation in relation to all people who come into regular contact with residents. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 40, 41, 42, 43 Residents are appropriately consulted on the management of the home. There are written policies and procedures in place to protect their best interests. Record keeping needs some improvement to fully meet their needs and some further action is needed to protect their health and safety. Improvements are needed to make the business more competent and accountable. EVIDENCE: Both residents stated that they are very satisfied with the care and services provided to them at the home during interviews held in private with them at their respective day placements. One has been admitted quite recently, so has not yet been included in the home’s quality assurance programme. The other has completed a satisfaction questionnaire and is fully involved in the formal care planning process. The written policies and procedures reflect care practice in the home. They are clear and well written, easily accessible and signed and dated by the registered provider. There are written procedures and records of
Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 17 equipment tests and checks to make sure that residents are safe in the home although the registered provider should undertake a written risk assessment of the premises. Most records required to protect residents are in place apart from a written care plan for one of them and there are suitable storage facilities for maintaining confidentiality. The registered provider has drawn up an annual development plan for the home but this requires more detail, particularly in relation to costs. There needs to be sufficient insurance cover in place for the business to fully protect residents and the business. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 4 4 x 3 x x Standard No 31 32 33 34 35 36 Score x x x 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Avalon Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 3 2 2 2 D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation Requirement Timescale for action 30/08/05 2. 6, 9, 41 3. 25(1) 25(2)(e) 12(1)(a) There must be full assessment 12(1)(b) information provided for all 14(1)(a-c) service users admitted to the home, with evidence of consultation and agreement unless there is a record that this is impracticable. 12(1)(a) Each service user must be 13(4) provided with a written care 15(1) plan, which is drawn up in 15(2)(a) consultation with them. This 17(1)(a) must include clear attention to risks and management of risks. 43 The registered provider have sufficient insurance cover in place to meet their legal liabilities to a minimum of £5 million. This requirement was previously notified for compliance by 31/04/05. It has been re-notified to enable the registered provider to find an insurance company that will provide this cover. 30/08/05 30/08/05 Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 2 20 24 , 42 43 Good Practice Recommendations The registered provider should ensure that assessment information for all serivce users covers all the points listed under standard 2.3 of the National Minimum Standards The registered provider should undertake training in the safe handling of medicines. The registered provider should draw up a written risk assessment in relation to the homes environment. The homes annual development plan should provide more detail and include costs/ budgets. Avalon D52-D04 S8952 Avalon V239798 210705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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