CARE HOME ADULTS 18-65
Avalon House 114-116 Manor Avenue Brockley London SE4 1TE Lead Inspector
Rossella Volpi Unannounced Inspection 27 February 2006 Avalon House DS0000025605.V284774.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 House DS0000025605.V284774.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 House DS0000025605.V284774.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Avalon House Address 114-116 Manor Avenue Brockley London SE4 1TE 0208 6942717 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) admin@avoracharity.org.uk Aurora Charity Angela Browne Care Home 12 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for 12 persons with a learning disability, one of whom may be a wheelchair user 17th August 2005 Date of last inspection 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. There had been a recent change of chief executive. 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 DS0000025605.V284774.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and included one visit conducted over half day in the afternoon and early evening of 27 February 2006. The findings were informed by general observations, discussion with two residents, discussion with staff and senior management, a tour of the premises and inspection of records. What the service does well: What has improved since the last inspection? Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 6 The periodic maintenance of the premises had continued, which meant that some areas had been decorated since the previous inspection. More work had been done to develop new projects such as gardening and cooking, to progress residents’ involvement in their home and to support them to more fully participate, as well as to increase the range of activities inside the home. Progress had been made regarding making care plans more holistic, with priority given to the development of the residents’ personal centred planning. As placing authorities did not fund holidays and the residents were expected to pay for those, it was very positive that the provider was giving some financial help to assist residents, when they could not otherwise afford holidays. This was an additional step to the continuing efforts to raise this matter with the placing authority to ask for funding. Following from a recommendation from the previous inspection, discussion was held with staff to clarify what they were expected to do in case of allegations or suspicion of abuse. 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 DS0000025605.V284774.R01.S.doc Version 5.1 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 House DS0000025605.V284774.R01.S.doc Version 5.1 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 the following 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 DS0000025605.V284774.R01.S.doc Version 5.1 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 the following standard(s): 6, 7, 8, 9, 10 Residents were assisted to make choices, consulted about the service provided, their independence was promoted and privacy respected. Therefore the residents took active part in decision-making and had some control over their life. EVIDENCE: The positive findings from previous inspections were again confirmed by discussion with two residents, discussion with staff and inspection of files. The home had been exploring ways to increase residents’ participation and involvement and was helped in this by an external specialist organisation. For example it was found at the previous inspection that 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 residents were pleased with the steps taken to effectively promote choice, independence and consultation. They also spoke again (as they did at the previous inspection) of the new projects introduced such as cooking and gardening. One resident in particular gave several examples, mainly though photographs,
Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 10 of activities in which the resident and others had been involved; it was apparent, from what the person said, that choices were offered and the risks involved in the activities were explained and minimised. Another resident spoke about daily living and showed his personal care plan, which addressed the main areas of his daily life, his preferences and aspirations. It was evident that the home had worked well with the resident and was continuing to support him to develop a care plan that reflected the whole person and centred on the resident’s choices and ambitions. The care plans kept on file, (i.e. those mainly completed by the home, although in consultation with residents), had not yet been fully audited to comply with the requirement previously imposed. However, discussion with the service manager about this, showed that progress had been made. She said that the weaknesses with the care plans had been identified and had been acted upon. They were not yet completed because priority had been given to the development of the personal centred planning with the residents (as referred to above) and to training of staff to equip them with the skills to support personal centred planning well. Residents were aware of their rights regarding privacy. Files were kept secure and with due regard for confidentiality. Residents had access to their own files. Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 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 the following standard(s): None This area was not looked at in sufficient detail on this occasion to enable a judgement, but was considered satisfactory at the previous inspection. EVIDENCE: The judgement on the previous inspection report, based on outcomes for standards 11, 12, 13, 14, 15, 16, and 17, was that 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. Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 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 the following standard(s): 18, 19 Residents received personal support that enabled them to exercise choice, control and achieve an individual lifestyle, which matched their preferences and needs. Residents’ health care needs were assessed and met with the support of staff at the home and by working with external professionals. EVIDENCE: There was evidence, from discussion with two residents, staff and the records inspected, that residents received personal support in the way they required and preferred. Care plans, drawn with the residents, identified the support needed and the way in which it should be offered. Consistency was provided through allocated keyworkers, who assisted in the drawing up of individual plans. There were both women and men in the staff team, to enable intimate care to be provided by a person of the same sex, if possible and always (staff said) if the resident wanted this. Staff discussed how they promoted privacy and during the time at the home it was noted that staff treated residents with respect. Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 13 Routines (such as times for meals, getting up, going to bed etc), were flexible, but residents were supported to have regular routines so that they could benefit from the range of activities in which they were engaged daily. Residents were guided, if needed, with personal hygiene. Some of the residents had complex needs and some could not easily communicate these. There were individual working records setting out the preferred routine, likes and dislikes. The home was committed to working in partnership with families, advocates and relevant professionals, subject to residents’ consent. The home monitored the health of the residents and health records were maintained on individuals’ files. 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. Residents were encouraged to go for dental, eye and other health checks as necessary. Specialist support was provided by the local community team and had included, for example, psychology, speech and language therapy, physiotherapy and other specialist health care. CSCI has queried, during inspections, staffing levels at night, which comprised sleeping-in staff only. The service manager assured again that the home remained vigilant about staffing arrangements at night. She assured that management would take immediate steps to institute waking night staff, should this seem to better meet the needs of residents or minimise risks. Avalon House DS0000025605.V284774.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): None This area was not looked at in sufficient detail on this occasion to enable a judgement, but was considered satisfactory at the previous inspection. EVIDENCE: The judgement on the previous inspection report, based on outcomes for standards 22 and 23, was that 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. Avalon House DS0000025605.V284774.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, 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 key standards looked at on this occasion had already been assessed as satisfactory at the previous inspection. However they were looked at again as part of a tour of the premises conducted by two residents, who also showed their bedrooms. The residents liked their home and found it comfortable. The home was fully furnished and, it was understood, residents would be involved in the choosing of furniture and decorations. The bedrooms were personalised and the residents were proud of their rooms. The organisation had continued to refurbish key areas. The premises were clean. Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 16 There were 12 single bedrooms, located on all four floors, although two of the residents’ bedrooms were not occupied. One bedroom on the lower ground floor was adapted to make it suitable for somebody using a wheelchair. 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 home had an infection control policy. Laundry facilities 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, to control risk of infection. A discussion was held with the service manager, during the inspection, regarding a proposal of Avalon using the two present vacancies to offer shortterm breaks. This would be to clients whose families needed some respite from caring. It was concluded that this would not be a suitable activity for the home. (The reasons were confirmed in writing separately from this report). Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 17 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): 34 The home recognised the importance of appropriately assessing prospective staff, but there were some gaps identified in the recruitment procedure that needed to be remedied, to make vetting more robust. EVIDENCE: Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 18 The home was recruiting at the time of inspection. The recruitment procedure was discussed with the service manager. The organisation assessed the suitability of prospective staff to work with vulnerable adults and to assess their skills and attitudes, prior to engaging them. The vetting process included applicants completing an application form, giving details of employment and education history, an interview, the following up of references and other statutory checks. It was discussed with the service manager that references should be verified by telephone calls and the outcome recorded. Also that, should there be convictions or other concerns, the service manager should record how their relevance had been considered and the reasons for the action taken regarding the appointment. The recruitment records of staff at the home were inspected. There were some gaps in the process, on three of the files, which needed to be rectified. These related, in one case, to the criminal record bureau check (CRB). Although the person had a CRB from a previous employer, a new one had not been conducted by the home yet and the protection of vulnerable adults list had not been checked. In the other two cases there was no evidence that gaps in the education or employment history had been followed up and explained. These were discussed with the service manager during the inspection, who said that she would rectify the omissions without delay. Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 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 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, 39 Residents benefited from a home managed by suitably qualified and experienced managers, internal and external to the home. The provider endeavoured to run the service in the best interest of residents and used quality assurance tools aimed at finding out residents’ views and acting on them. EVIDENCE: The manager had several years experience of working with people with learning disabilities and over six years experience as a manager. She had been following relevant courses to achieve the required qualifications, in care and management. The organisation had a management structure that included two senior managers external to the home (the service manager and the chief executive). Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 20 There was a comprehensive system of quality assurance, common to a number of the Aurora’s homes. This was based on seeking the views of residents through house meetings, key worker sessions and users’ satisfaction surveys. Advocates were involved in supporting users to express their views or fill questionnaires. Quality was also monitored by the manager through supervision and appraisal of staff, annual training programme for staff and internal audits. The home had a complaints’ procedure. The organisation drew up a yearly development plan, based on the views of service users and their families. Health and safety inspections took place and external accountants audited the organisation’s accounts. (These were not looked at). Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 21 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 x 23 x ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 2 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 4 4 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x x 3 x 3 x x x x Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 22 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 YA6 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 01/02/06 was partly met). Timescale for action 01/08/06 Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 23 2 YA34 19 (1) (a) (b) The registered provider must review staff files to identify any gaps in the vetting procedure and take appropriate action to address them. 01/06/06 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 YA14 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. (This recommendation from the previous inspection was not followed up on this occasion) 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. (This recommendation from the previous inspection was not followed up on this occasion) 2. YA16 Avalon House DS0000025605.V284774.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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