CARE HOME ADULTS 18-65
Avalon House 114-116 Manor Avenue Brockley London SE4 1TE Lead Inspector
Rossella Volpi Unannounced 17 August 2005 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 House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Avalon House Address 114-116 Manor Avenue Brockley London SE4 1TE 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) 020 8694 2717 Aurora Charity Angela Browne CRH care home PC care home only 12 Category(ies) of LD Learning Disability registration, with number PD Physical Disability of places Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: This home is registered for 12 persons with a learning disability, one of whom may be a wheelchair user Date of last inspection 9 November 2004 Brief Description of the Service: Avalon House provides a care home to a maximum of twelve women and men with severe learning disabilities, who might also have other support needs. The overall aim is that of providing a service driven by the needs, abilities and aspirations of the service users and placing their rights at the forefront. The home declares its core values to be: individual approaches, equal opportunities, inclusion and shared values. Avalon House aims to achieve this by ensuring that the service would be based on a thorough assessment of needs and delivered in collaboration with external agencies. Staff would seek to advance the rights to privacy, dignity, independence, security, civil rights, choice and fulfilment in all aspects of their work and of the environment. The provider is an organisation named: ‘The Aurora Charity’, which also runs other homes. A chief executive and a service manager, to whom all the staff are ultimately accountable, direct the service. The day-to-day running of the home is delegated to a care manager, who leads a team of staff. Accommodation is provided in two converted, adjacent, Victorian houses and is set on four floors. There is a small garden and a multi sensory room. There are 12 single bedrooms, none has en-suite facilities. Provision has been made for one of the bedrooms to accommodate a person using a wheelchair. There is a minibus to facilitate group outings. The area is served by public transport and has a selection of shops and a supermarket. Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and included one visit conducted on 17 August 2005, during lunchtime and afternoon. The findings were informed by general observations, discussion with two residents (although comments from one resident were very brief and mainly related to some leisure activities), discussion with staff and senior management, a tour of the premises and inspection of records. Not all core standards were inspected on this occasion, but it is intended that, during the inspection year (April 2005 to March 2006) all core standards would be inspected. What the service does well:
It was evident, both from what the residents said and from direct observations, that residents felt at ease in the home, related well to staff, were supported to make choices and were treated with respect. For example, one resident said that she was consulted about areas important to her and gave some examples of how she had been assisted to act on her choices. She spoke about the new projects introduced such as cooking and gardening and expressed satisfaction with the range of activities pursued. Another resident was also positive about activities he was involved in. Clearly residents were assisted to make choices, took part in decision-making and had some control over their life. Staff endeavoured to enable residents to achieve a fulfilling lifestyle by ensuring that they had opportunities for education and training, work and leisure activities. The majority of residents had continued to attend classes or a local day centre and they were supported in using local facilities, such us pubs, shops, leisure centres or other amenities in the area. Day trips and holidays were planned and organised with the residents. Health needs were met by staff and health specialists. Staff endeavoured to provide healthy meals, which reflected the residents’ preferences. The resident (with whom this was discussed) said that she could and would raise concerns, if any and gave one example of when she had done that. The home took seriously their responsibility of protecting residents and ensuring that staff would be guided by a clear procedure. Staff were clear about their roles and received regular training. The resident interviewed found the home, overall, comfortable and meeting her needs. The home offered single bedrooms and shared facilities. Attempts had been made to embellish the environment so as to create a homely feel, although the size of the premises did not fully support this.
Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 6 The home had a policy on health and safety. Regular risk assessments were conducted. Mandatory training for staff included health and safety training (including moving and handling and fire safety). What has improved since the last inspection? 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 House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home was committed to a full assessment of residents’ needs and aspirations. This would therefore enable appropriate care and support, to meet residents’ individual needs. EVIDENCE: No new resident had come to live at the home in recent years. The policy of the organisation in relation to any future admissions was that prospective residents would receive a full assessment, by the appropriate professionals. Only then the home would confirm the offer of a place, if the identified needs and aspirations could be met. Staff confirmed that all residents had a care plan and these were seen on the files inspected. Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 Residents were assisted to make choices, consulted about the service provided and their independence was promoted. Therefore the residents took active part in decision-making and had some control over their life. EVIDENCE: At the previous inspection the manager had discussed how the home was exploring ways to increase residents’ participation and involvement and was helped in this by an external specialist organisation. For example documents on the notice board had been redrafted in alternative formats to increase accessibility, while the users’ guide and menus had been produced in pictorial form. This had continued and the home was taking more steps to become more effective in promoting choice, independence and consultation. This was evident from discussion with a senior member of staff, one resident and inspection of records. The resident was satisfied that she was consulted about areas important to her and assisted to act on her choices. She gave some concrete examples of the above (with some prompting). Staff and the resident spoke about the new projects introduced such as cooking and gardening. Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 10 The senior member of staff said that there were risk assessments for all residents, which reflected their changing needs and showed examples of the ones she had made in relation to the new projects. Direct observation was made of a group of residents coming back to the home at lunchtime and engaging in a number of activities and interactions with each other and staff. This showed that they were generally relaxed and confident about choosing what to do, deciding what to eat and preparing their meals, with staff assisting appropriately. Some limitations arose for individuals from their disabilities. For example none of the residents were able to manage their own finances; but staff were supporting them in opening individual bank accounts into which their benefits would be paid. The home was working towards making care planning more holistic, consistently with the principles of personal centred planning and that would also contribute to the enhancement of choice, participation and independence. However discussion could not be held with the manager regarding the requirement previously imposed on care planning. Therefore it was not possible to properly assess progress made, although some discussion was held with another member of staff. The requirement and previous score under the standard are therefore repeated, (slightly amended), but no new action plan is required as there was evidence that appropriate steps were being taken. Avalon House G52-G02 S25605 Avalon V245437 170805 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) 11, 12, 13, 14, 15, 16, 17 Residents were supported to lead meaningful lives, appropriate to their peer group, aspirations and preferences. Staff endeavoured to ensure that residents could enjoy healthy meals, had opportunities for education and training, work, leisure activities and had a real say about the running of the home. This enabled residents to achieve a fulfilling lifestyle. This would be enhanced by the more holistic care plans and more comprehensive reviews the home was working towards. EVIDENCE: Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 12 The resident with whom this was discussed described a range of activities she was involved in. It was clear from what she said that she expressed her preferences and staff had helped with making changes when required. She spoke of the day centre, holidays and some outings as well as relationships with friends and family. Another resident’s comments were also positive about some activities he was involved in, although the comments from him were very brief. A resident from another home, who worked part-time at Avalon and had friends there, confirmed that visits from friends and families were supported and encouraged. These comments were consistent with the positive feedback received from residents or their relatives at the previous inspection. The senior member of staff gave examples of ways in which residents were supported in taking responsibility in their daily life, including assessing risks and how to minimise them. She also described some of the activities residents had been engaged in. These included leisure, education, practical skills in cookery and gardening. The majority of residents had continued to attend classes or a local day centre and they were supported in using local facilities, such us pubs, shops, leisure centres or other amenities in the area. Residents had a choice of food and meals and pictorial aids were used to better enable this. Individual cooking sessions were held once a fortnight and it was planned to enable residents to assist the cook, regularly, in the preparation of meals. The senior member of staff gave examples, (including showing the entries on the care plans), that nutritional needs were regularly reviewed, that there was information on the individual dietary requirements and that cultural diversity was reflected on the range of food or meals being proposed. It was pointed out in previous reports that the home is expected to provide full board and should contribute towards some of the cost to residents of lunches taken out. The provider had acted on the recommendation. The home was funding lunches for residents on those occasions when taking sandwiches from the home would not be a realistic option and eating out was an essential activity for the person in residence. The home arranged holidays and supported the residents to choose and plan them. A recurring issue from previous inspections was that placing authorities did not fund holidays, thus they were funded by the residents. The provider has already confirmed their commitment to continue to raise this matter with the placing authority; however the previous recommendation is repeated, as this is an ongoing issue until resolved. It was very positive that the provider had introduced some financial help for residents to assist with the cost of holidays when the resident could not otherwise afford them or to enable a more expensive holiday than the resident could pay for. Some tensions had been identified at the previous inspection, in the area of smoking and drinking, between promoting individual rights and safeguarding staff and other residents. On this occasion the provider discussed how the home was balancing the tensions and also complying with health and safety
Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 13 requirements imposed by external statutory bodies, regarding smoking. It was positive that the provider was having such discussions with the residents and the staff. It is recommended that these continue and involve external professionals with experience of promoting users’ rights for the client group. Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 14 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) 19, 20 Residents’ health care needs were assessed and recognised; staff strived to provide personal and emotional support responsive to individual preferences and targeted to meet identified needs. EVIDENCE: It was not possible to discuss this area with the residents, who had lost interest in this discussion. The area was reviewed with the senior member of staff who also illustrated some examples with reference to the care plans for two residents, including their medication charts. The home monitored the health of the residents. Residents were all registered with a general practitioner; their files detailed health care appointments and indicated that they had access to the full range of health care professionals. None of the residents administered their own medications, as none were deemed able to manage this safely. Staff, all of whom would be trained, therefore administered these. There were policies and procedures in place at the home covering medication administration. The record of medication, from inspection of some entries at random, was clear and accurate. Staff stated how the home put due emphasis on appropriate personal care, which was seen as essential to promote confidence and self-respect.
Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Residents’ views and feelings where sought and acted upon. The provider had set procedures, discussed with residents and their families, for responding to issues raised, so that residents could be protected from abuse, neglect and self-harm. EVIDENCE: The resident with whom this was discussed said that she could and would raise concerns with her key-worker and her family; she gave some examples of when she had done that. As mentioned in previous reports, the home helped users to understand the complaints’ process also using a video. It was understood that the complaints’ procedure had been discussed with and issued to all relatives or users’ representative (and the comments received from relatives at the previous inspection confirmed that they were aware of the procedure). The involvement of advocates in the home was an additional safeguard. The home had recently drafted a new adult protection procedure to ensure that staff would be clear of the actions expected in case of allegations or suspicion of abuse. Adult protection was part of the mandatory training for staff. There was some inconsistency between the understanding of senior management and of staff about how it was ensured that staff would be completely clear of the adult protection procedure. This was discussed with the provider during the inspection. There were policies governing the handling of residents’ money and financial affairs, which precluded staff from making or benefiting from residents’ wills. The home was opening individual accounts for each resident. Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 16 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, 25, 30 The home offered single, comfortable bedrooms and shared facilities. Attempts had been made to embellish the environment so as to create a homely feel for the residents. The size of the premises (in particular that there were 12 bedrooms) was not wholly consistent with the provider’s ethos and objectives. EVIDENCE: The resident interviewed found the home comfortable and meeting her needs, although she pointed out that she did not like to have to climb stairs to go to her bedroom. There were 12 single bedrooms, located on all four floors, although two of the residents’ bedrooms were not occupied. One of the bedrooms on the lower ground floor was adapted to make it possible for somebody using a wheelchair to be accommodated. The room had easy access, on the same level, to the shower room and toilet, kitchen, dining room and garden. Access to the lounges was via a chair stair lift. A person with a wheelchair could only enter the property via the back gate, as access to the front entrance was via stairs. There were longer-term plans to improve outside access, as part of a disability assessment that was undertaken for the premises. The organisation had continued to refurbish key areas. The premises were clean.
Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 17 Both laundry rooms were sited away from the kitchen and food storage areas; one washing machine had a sluicing facility. Both machines were capable of washing clothes at temperatures in excess of 65oC, which is the minimum temperature recommended to thoroughly clean linen and control risk of infection. The home had an infection control policy. Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 18 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) 31, 35 Residents benefited from a staff team who was clear about their roles and responsibilities and who received regular training. This would enable staff to appropriately support the residents. EVIDENCE: The senior member of staff confirmed that there were job descriptions for all staff. The job descriptions identified roles and responsibilities within the home and organisation. Staff had been made aware and had been given copies of the General Social Care Council’s code of conduct. She was aware of the accountabilities within the team and of senior management. The organisation was taking steps to ensure that at least 50 of care staff would achieved a care national vocational qualification (NVQ at level 2 or 3) by the end of 2005. The home had training and development programmes and a dedicated training budget. (Development plans were not seen at this inspection). The service manager confirmed that the identified mandatory training for staff continued to be planned at the required interval and that staff had attended other relevant courses. Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 19 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) 42 The health and safety of residents and staff was promoted, as far as it was reasonably practicable. EVIDENCE: The home had a policy on health and safety. Regular risk assessemnts were conducted. Mandatory training for staff included health and safety training (including moving and handling and fire safety). Environmental health had visited in September 2002, the fire officer had visited during 2003 and again in 2005 and the provider appointed health and safety officer visited every 3 months. The provider conformed that all recommendation by the fire officer were being complied with, even though he had contested some. The provider also confirmed that fire drills were conducted regularly (records were not looked at, as the fire inspection had been recent). Contracts were in place for servicing the fire safety system, the boiler, central heating system and the emergency call system. Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 20 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 3 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Avalon House Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 21 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 6 Regulation 15 (1), (2) Requirement The registered provider must continue to audit care plans, to ensure that they are holistic and consistent with the ethos and values of the organisation. In particular that: - Care plans give a picture of the person as a whole, with emphasis also given to cultural and other identity issues. - Guidelines are developed for staff supporting users with developmental goals. - Developmental and maintenance objectives are separated from tasks, to enable clearer monitoring, evaluation, review and update of objectives. - Recording includes what is learnt from supporting the service user. - When there are communication issues, information is kept around what the person does, what the staff think it means and when it happens. (Previous time scale of 1 July 2005 was partly met and the provider had taken appropriate steps).
Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 22 Timescale for action 1 February 2006 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 14 Good Practice Recommendations That the provider continues discussion with the placing authorities to establish, as part of the basic contract price, the option of a minimum seven-day annual holiday outside the home for each resident. That the provider involves external people, with experience of promoting users’ rights for the client group, to contribute to the review of how residents rights are safeguarded. That the provider discusses again with the manager and senior staff in the home how it is ensured that staff are clear of what they are expected to do in case of allegations or suspicion of abuse. (For example whether the provider expects this to be part of induction, an agenda item periodically looked at supervision or discussed at staff meetings, etc.) 2. 16 3. 23 Avalon House G52-G02 S25605 Avalon V245437 170805 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 46 Loman Street London SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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