Inspection on 24/04/07 for Avalon

This inspection was carried out on 24th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Avalon 31/01/06

Avalon 21/07/05

Avalon 04/01/05

Avalon 15/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Avalon Brea Farm St Buryan Penzance Cornwall TR19 6JB Lead Inspector Richard Coates Key Unannounced Inspection 24th April 2007 12:00 Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 1 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 Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 2 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 Stationery 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 DS0000008952.V336998.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avalon Address Brea Farm St Buryan Penzance Cornwall TR19 6JB 01736 871876 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) nick@avalon5.co.uk Mrs Amanda Gloria Nicholson Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: Avalon is a care home providing accommodation and personal care for up to three adults with a learning disability. Avalon is owned and managed by the registered provider, Amanda Nicholson, who lives at the home with her husband. The house is a single storey building situated outside the village of St. Buryan, west of Penzance. It is set in its own extensive grounds slightly off the main road. There are horses, dogs and other animals. The location is very rural; there are buses to the main towns. Residents have their own bedrooms and a shared bathroom. There is ample communal space. 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 support for residents. Residents attend a range of activities outside the home. The home is not intended to be suitable for people who require a lot of assistance with their personal care. The fees were given in April 2007 as £330.00 weekly. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a planned unannounced inspection to review compliance with the requirements set in the last inspection report dated 31 January 2006 and to inspect against the national minimum standards identified as key standards by the commission. The provider submitted a pre-inspection questionnaire for the inspection visit. The inspector spent time at the home inspecting records and documents, touring the premises and having discussions with the registered provider and residents. The residents submitted comment cards before the inspection. What the service does well: What has improved since the last inspection? The provider has added a new en-suite bedroom which will provide improved accommodation. The current small bedroom will become a computer room. The residents will occupy the two larger of the current bedrooms and the new room. This will result in only two residents sharing the bathroom. The provider has repainted and refurbished the resident’s bedrooms during the year, with replacement carpets, a new bed for one room, and new bed linen. A Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 6 full doorway has been installed to replace a window to provide direct access from one resident’s bedroom to the conservatory. An area outside the home has been fitted out with decking, so that the residents have a pleasant area for spending time outside in good weather. What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider’s policy and practice ensure that prospective residents and their representatives receive information about the home in order to make an informed choice. The needs and aspirations of a resident who was recently admitted to the home were effectively assessed so that the provider felt confident that these needs could be met. EVIDENCE: One resident had been admitted since the last inspection. The provider had obtained a copy of the social work assessment and admission information from Cornwall Department of Adult Social Care. The resident had previous contact with, and knowledge of, the home before deciding to move in. The provider drew up an initial care plan from the assessment and commissioning information provided. A copy of the standard Cornwall Department of Adult Social Care commissioning contract was on file. The provider issues a copy of the service user guide to new residents. The recently admitted resident reported that he liked living at the home and felt well cared for and safe. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The written care plans reflect the changing needs and personal goals of residents so that the provider can provide effective care. The provider supports residents to make decisions and take risks as part of an independent lifestyle. EVIDENCE: All three service users have detailed written care plans, which fully address their health, personal and social care needs, including needs relating to their backgrounds and culture. The care plans include a ‘Person Centred Approach’ record where the resident can set out their lifestyle preferences and the things that are important to them. The care plans include information about each resident’s weekday activities. We discussed improvements to the recording of reviews. The provider carries out a review every six months and involves Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 10 residents in this process, but the outcomes of this are not consistently recorded in a dated record. The records show that the provider regularly attends reviews at the residents’ weekday placements. Residents are encouraged to develop their skills and independence, and to enjoy ordinary valued living in the community. They have their own keys to the building and go out in the community independently. There are written risk assessments covering activities and potential areas of risk. The registered provider has made suitable practical arrangements to ensure the safety of residents. Residents were very positive about the support they received to make decisions, engage in activities they enjoy and manage their lives. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider supports residents to take part in social and leisure activities in the home and in the local community. Residents eat a varied diet and enjoy their mealtimes. EVIDENCE: 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 placements in the local community. This forms part of their individual package of care commissioned by Cornwall Department of Adult Social Care and includes attendance, for example, at Heather Lane Nursery, Moorvue, a rural activity centre, and the John Daniel Centre. Residents expressed satisfaction with these activities. Residents were satisfied with the leisure activities available and reported that Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 12 they were able to participate in their preferred activities. Their rooms demonstrated their interests, for example, in music, television, sports and playstation. The provider supports residents in attending local clubs and, for example, going shopping in Penzance. The home has horses, dogs and other animals, and residents are able to become involved in caring for them. The provider is happy for residents to receive visitors at the home. Generally, however, the residents visit their families and other friends. All three residents have their own mobile telephones and telephone their families regularly. The daily care records and menus submitted by the provider demonstrate that they are provided with a range of healthy, home prepared meals. A resident reported that the food was “lovely”. They enjoyed visiting the supermarket to make their choices and help plan the menus, and the provider had introduced them to new dishes, which they now enjoyed. They have access to snacks, hot and cold drinks. None of the current residents has any specific dietary needs. However, the provider has developed her knowledge in this area, for example in relation to diabetes. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ preferences and views are taken into account in meeting their personal care and health care needs. The procedures and practice for medicines protect residents, but could be developed further. EVIDENCE: The residents are mainly independent in their personal care, washing, dressing and grooming. They were appropriately dressed in relation to their age and current styles, and all have a good choice of clothes. They share a bathroom, which is located close to their bedrooms and offers them privacy. This situation will improve further when a new bedroom with en-suite facilities is commissioned. The registered provider offers support as necessary and this is reflected in their individual daily care records. The residents’ physical and emotional healthcare needs are addressed in their care plans. They are registered with local GP practices. The provider supports Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 14 them to access services according to their individual needs. The records show regular appointments with, for example, opticians and dentists. The current residents do not take regular prescribed medication; there were no prescribed medicines in use at the time of the inspection. The provider has a basic written policy, which allows residents to take responsibility for some aspects of medication. We discussed how the provider could further support residents to manage their own medicines when required, subject to a risk assessment. When the provider does administer medicines to residents, the resident should sign a written consent to this. The provider agreed to address these matters when next a resident requires prescribed medicines. There are suitable storage facilities for medicines when they are needed. The registered provider keeps this situation under review. The pharmacist visited to give advice on 2 February 2007. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider has a complaints procedure so that the views of residents and their representatives should be listened to. The arrangements for the protection of vulnerable adults safeguard residents. EVIDENCE: All three residents have good communication skills. Residents stated that they are well cared for and satisfied with the services and facilities at the home. They did not identify any areas in which they felt that provider could do better. They reported that Mrs Nicholson and her husband are very approachable, and deal with any concerns that they might have. Their views of the quality of care provided to them are regularly sought as part of the quality assurance programme. There is a written formal complaints procedure, which has been supplied to them, and is posted on the notice board. The provider has received no formal complaints since the last inspection. Residents have regular contact with friends, relatives and professionals from outside of the home. There is good communication between the home and their day placements. Mrs Nicholson attends reviews at day placement centres. She has attended local multi-agency 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 Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 16 is based on the Department of Health guidance “No Secrets”. The provider’s copy of the local multi-agency code of practice was not the most recent version; she telephoned and requested a copy of this from Cornwall Department of Adult Social Care during the inspection. 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. We inspected a sample of the records of residents’ signatures to acknowledge receipt of their weekly personal allowance. These appeared to be satisfactory. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents live in a comfortable, spacious, clean and well-maintained home, which provides a safe and suitable environment. EVIDENCE: Avalon is situated in a rural setting west of Penzance. It is a single floor building providing residents with a comfortable domestic style dwelling. The home appeared clean, tidy and safe at the time of the unannounced inspection. The premises were in good decorative order, with good quality domestic furnishings throughout. The communal space consists of the kitchen/dining area, a large lounge and three conservatories. The three residents’ bedrooms are all single. Residents reported that they were satisfied with the accommodation provided. They said that their bedrooms were comfortable Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 18 and provided the facilities they required. At the time of the inspection, the provider was about to complete and commission a new additional bedroom with en suite shower, hand basin and toilet. There is no plan to increase the registered numbers. The smallest bedroom will become a computer room, and the residents will occupy the two larger existing bedrooms, and the new room. When this new room is commissioned, only two residents, who both have hand basins in their rooms, will share the main bathroom. Residents personalise their rooms, keep them as they wish, and can secure them. They all have their own television and music equipment. They have adequate storage space to meet their needs. The maintenance records show the repainting of residents’ rooms, and refurbishment, including new carpets, the replacement of a bed in one room, and new bedding. One bedroom has been improved with an access door into a conservatory; the provider has plans for improving this conservatory. The grounds are spacious. There are horses, dogs and other animals and the residents can get involved with these if they choose. The garden close to the house has been improved with the fitting out of an area of decking close to the house. The laundry is completed in a domestic washing machine in the kitchen. The provider has suitable bags and gloves to deal with incontinence incidents, but this is not an issue with the current residents. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 19 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider delivers effective support to service users. The provider has completed appropriate training to meet the needs of residents. EVIDENCE: The registered provider undertakes all the care and personal support needed in the home and employs no staff. It is, therefore, not possible to comment on the recruitment standard in detail. The provider runs the home on a domestic scale; residents experience a pattern of living close to a family situation. The registered provider’s sister is available to provide short-term care in times of emergency. Service users are familiar with her, as she often visits the home. There is documentary evidence that she is suitable to work with vulnerable adults in a care setting on a voluntary basis, should the need arise. Service users visit their families, who live nearby, when the registered providers have a break. The registered provider has completed a range of training in order to undertake her role, and this is detailed in the management section. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 20 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is effectively run to fulfil its aims and objectives and to meet the needs and aspirations of the residents. The provider takes actions to ensure the safety and welfare of the residents. EVIDENCE: Mrs Nicholson, the registered person, is providing accommodation and care in her own home and is in active daily charge. She is registered as provider and manager with the commission. She has undertaken regular training to update her knowledge and skills and has completed training to NVQ level 3 in care, Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 21 proportionate to the size and nature of the home, and in health and safety, first aid and adult protection. The provider maintains the records required by law and to ensure the best interests of residents. They were securely stored and appeared to be up-todate and accurate at the time of the unannounced inspection. Residents are asked to complete a written questionnaire twice yearly as part of the review of their care and the quality assurance process. There is a written ‘code of conduct’ which details the standard of services provided. The records demonstrate that the home is regularly checked and kept safe from the risk of fire and other hazards. The provider submitted a list of required safety and maintenance records with the pre-inspection questionnaire. We checked a sample of these against original documents and found them to be accurate. The provider carries out regular fire drills with simulated evacuations. The fire detectors are wired in a linked system. There are records of regular checks on the alarm system. The provider has completed a fire safety risk assessment and fire instructions, which are displayed. She is awaiting an inspection from the fire service. There is suitable fire-fighting equipment. The registered provider has suitable information and equipment to prevent the spread of infection in the home. There is appropriate health and safety information. Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 23 No 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA6 Good Practice Recommendations The registered provider should complete a dated record of the outcomes of the six monthly reviews. The records should provide evidence of the service users’ participation. The provider should develop a written agreement to the administration of medicines when there is next a resident in the home who requires their medicine to be administered. 2 YA20 Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Avalon DS0000008952.V336998.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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