CARE HOME ADULTS 18-65
Avalon Brea Farm St Buryan Penzance Cornwall TR19 6JB Lead Inspector
Lowenna Harty Unannounced Inspection 31st January 2006 10:00 Avalon DS0000008952.V281406.R01.S.doc Version 5.1 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.V281406.R01.S.doc Version 5.1 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.V281406.R01.S.doc Version 5.1 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.V281406.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st July 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 partner. The home 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 from Penzance. The location is very rural although there are buses to the main towns. Service users have their own bedrooms and a shared bathroom. There is ample communal space with a choice of lounges. The home provides good access for people with physical disabilities. No staff are employed to work at the home and the registered provider undertakes all the care and support to service users herself. Service users are expected to participate in a range of activities outside of the home during the week and it is not suitable for people with extensive personal care needs. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 31 January 2006 and lasted for approximately two hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. Because the service users were out at their various day placements, the inspection focused on inspection of the premises, examination of care, safety and employment records and discussion with the registered provider during the day. A telephone interview was conducted with one of the service users, in private, subsequent to the visit to the home. Because of the small size and nature of the home it was possible to review both of the service users’ records in detail and follow this up with interviews held in private with one them. The home provides excellent care to the service users placed there, which the service user who was interviewed confirmed. They were particularly complementary of the food and activities provided to them. Of particular note was the contribution that service users are actively encouraged and supported to take part in with regard to service planning for people with learning disabilities, through the local partnership board. What the service does well:
Service users enjoy a good quality of life in the home. They have good information about their rights and responsibilities as residents of the home and enjoy their meals. The service user who was interviewed as part of the inspection confirmed this and was particularly complementary about the registered provider’s cooking. Service users’ physical and emotional healthcare needs are fully met and they are able to access a range of local healthcare providers when they need them, to ensure they remain healthy and feel well. There are suitable systems for medicines management, for the home’s current situation and the registered provider keeps them under review. Service users have good opportunities to make their views and feelings known to the registered provider, who respects them and they are well cared for, according to the service user who was interviewed at the time of the inspection. The home’s environment is comfortable and homely for service users. It was clean and tidy throughout at the time of the inspection. It is well decorated and furnished and provides service users with ample space indoors and out. It
Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 6 is suitable for service users who enjoy being part of a working farm in a rural setting as a life-style choice. The registered provider does not employ staff to work at the home and service users tend to visit their families, who live locally, when they need a break. The registered provider’s sister, who is well known to the service users, is able to assist in an emergency, although this has never yet arisen. There are records in the home to demonstrate that she is suitable to work with vulnerable people in a care setting. The home is well managed, for the benefit of the service users. The provider is registered with the Commission as a fit and suitable person to own and manage a care service for vulnerable adults and undertakes regular training to update her knowledge and skills. The home is kept mainly safe for service users in that there are good arrangements to protect them from fire risks and other environmental hazards in the home. The registered provider is trained in the provision of emergency first aid and health and safety. What has improved since the last inspection?
The registered provider has taken action to ensure that service users currently living in the home have written assessment documentation on their personal files, so that she has clear information on which to base their future care plans. She has drawn up an assessment form, which all prospective applicants need to complete so that she can be sure she has enough information to be confident that the home will be suitable for them. The new assessment forms address prospective service users’ personal, health and social care needs, including their needs relating to their backgrounds, religion and culture. Both service users have detailed written care plans, based on their assessed needs, which they have signed up to. These are person centred and provide them with clear goals so that they can develop their skills and independence. The registered provider has improved formal systems to ensure service users’ health and safety in the form of written environmental risk assessments, with risk management plans without detracting from the small-scale, domestic, “family” feel of the business. Record keeping in the home has improved and records required by law to protect service users and ensure their best interests are now held in the home. They are kept safely and confidentially and looked clear, well written and upto-date at the unannounced inspection. There is now sufficient insurance cover to meet the registered provider’s legal liabilities and protect service users. There is a clear business plan for the home, linked to the annual accounts to demonstrate the soundness of the business for the ongoing security of the service users placed at the home. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 7 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. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Avalon DS0000008952.V281406.R01.S.doc Version 5.1 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 the following standard(s): 2 Prospective service users’ individual aspirations and needs are assessed to ensure that the home will be suitable for them. EVIDENCE: There have been no new admissions since the previous inspection. Both service users have written assessments on their personal files, which address their personal, health and social care needs, including needs in relation to their backgrounds, religion and culture. Service users are admitted on the basis of completed assessments, according to the registered provider’s own format, to ensure that their needs are properly identified before they are admitted and can be met in the home’s setting. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 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 the following standard(s): 6&9 Service users have detailed, person centred care plans, suitable to meet their needs but these should be reviewed more regularly. They are supported and encouraged to take risks to develop their skills, independence and confidence but written assessments should back up practice in this respect. EVIDENCE: Both service users have detailed written care plans, which fully address their health, personal and social care needs, including needs relating to their backgrounds, religion and culture. The review format for one of them is very useful, in that it involves staff from their day placement, as well as the registered provider; is person centred and closely involves the service user, and is held regularly, every six months. It would be useful to extend this to the other service user, if possible. Service users regularly access the local community independently and the registered provider has put into place suitable practical arrangements to ensure their safety at all times. They were both out at their day placements in the local community at the time of the inspection. The registered provider should prepare more detailed written risk assessments to demonstrate the adequacy of her risk management strategies.
Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 11 Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 16 & 17 Service users are given clear information on their rights and responsibilities with regard to their placements in the home. They enjoy health, home prepared meals, which meet their needs and preferences. EVIDENCE: Service users’ written contracts, service users’ guides and care plans clearly set out what is expected of them and their rights in respect of their placements in the home. Both have been given copies and signed up to them. Service users’ care plans address their dietary needs and there are clear daily care records to demonstrate that they are provided with a range of healthy, home prepared meals. They have unlimited access to snacks, hot and cold drinks and service users are able to help with the shopping and menu planning. The service user interviewed as part of the inspection stated that they are very satisfied with the food provided to them. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 Service users health care needs are appropriately met arrangements to ensure safe handling of medicines are suitable for the home’s setting. EVIDENCE: Service users’ physical and emotional healthcare needs are fully addressed in their care plans. They are registered with local NHS healthcare providers and access them according to their individual needs. There are full records to support this. Current service users do not take regular medication. The home has a basic written policy, which allows for them to take responsibility for some aspects of medication, should they need it and there are suitable storage facilities for medicines when they are needed. The registered provider keeps this situation under review. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 22 The home has good formal and informal systems in place to ensure that service users’ views are listened to and acted upon. EVIDENCE: The service user who was interviewed during the inspection stated that they are well cared for and satisfied with the services they receive at the home. Service users’ views of the quality of care provided to them are regularly sought as part of the formal quality assurance programme in place and there is a formal complaints procedure, which has been supplied to them both. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 24 The home is comfortable and homely for service users so that they can develop their skills and independence in a safe environment. EVIDENCE: The home is a comfortable, domestic dwelling. It appeared clean, tidy and safe at the time of the unannounced inspection. It was well decorated and suitably furnished throughout. The registered provider has undertaken training in health and safety and has completed fire safety and environmental risk assessments on the home to make it safe for service users and themselves. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 35 There are suitable arrangements in place to ensure that service users are well cared for at all times. EVIDENCE: The registered provider undertakes all the care and personal support needed in the home and no staff are employed to work there. The registered provider’s sister is available to provide short-term care in times of emergency, and service users are familiar with her, as she often visits the home. There is suitable documentary evidence that she is suitable to work with vulnerable adults in a care setting on a voluntary basis, should the need arise, although this has not happened. Service users’ families live near by and they tend to visit them, when the registered providers need to have a break. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 41,42 & 43 The home is well run for the benefit of the service users. Records needed to protect service users’ rights and best interests are well written and safely stored. There are good arrangements to protect the health, safety and welfare of service users. The home is competently and accountably managed to provide security for service users in their placements there. EVIDENCE: The registered provider lives at and is in active daily charge of the home. She is registered as fit to be a provider and manger with the Commission. She undertakes regular training to update her knowledge and skills and has completed training to NVQ level 3 in care. Records required by law and to ensure the best interests of service users are maintained in the home. They are safely stored to ensure service users’ confidentiality and appeared to be up-to-date and accurate at the time of the unannounced inspection. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 18 The registered provider has undertaken training in the provision of emergency aid and health and safety. There are records to demonstrate that the home is regularly checked and kept safe from the risk of fire and other hazards. The registered provider has obtained sufficient insurance to cover her liabilities in respect of the business. There is a clear business plan, linked to the home’s annual accounts, which are held in the home and available for inspection. Records demonstrate the competent management of the home to provide a secure placement for service users living there. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 19 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 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X 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 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 3 X X X 3 3 3 Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 20 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. 2. Refer to Standard YA6 YA9 Good Practice Recommendations The registered provider should arrange for person centred reviews to be held every six months for all service users living in the home. The registered provider should prepare more detailed written risk assessments with clear risk management strategies to ensure service users are protected as far as possible, at all times, whilst retaining their independence. Avalon DS0000008952.V281406.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection St Austell Office 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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