Care Home: Avalon

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Avalon Brea Farm St Buryan Penzance Cornwall TR19 6JB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Avalon Brea Farm St Buryan Penzance Cornwall TR19 6JB 01736871876 Telephone number: Fax number: Email address: Provider web address: nick.avalon@talktalk.net Name of registered provider(s): Type of registration: Number of places registered: Mrs Amanda Gloria Nicholson care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 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 Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 3 Brief description of the care home assistance with their personal care. The fees were given as from 350 pounds/week. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited Avalon on the 15th April 2009 and spent approximately 3.5 hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that the needs of the people using the service are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. The Annual Quality Assurance Assessment (AQAA) document completed by the provider has also been considered to support this inspection. All of the key standards were inspected. On the day of inspection 3 people were living in the home. The methods used to undertake the inspection were to meet with a number of residents, and the registered provider to gain their views on the service. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of Care Homes for Adults (18-65 years) Page 6 of 27 this inspection. Residents expressed satisfaction with the care and services provided at the home. Overall the home is providing a good quality of care to the residents placed there. The registered provider is in day-to-day control and demonstrated an in-depth understanding of the needs and capabilities of the people that live at Avalon. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessment documentation and care plans are received from external agencies. All prospective residents are assessed by a competent person from the home prior to admission, with records maintained. The people who are thinking about a move to Avalon are provided with good information to help inform them about their choice of home. Evidence: Evidence was provided in the form of records, talking with staff and the registered provider. The files of three people that live at the home were inspected and these contained relevant and appropriate assessment documentation. One resident had been admitted since the last inspection. A copy of the standard Cornwall Department of Adult Social Care commissioning contract was on file. The registered provider carefully considers the care needs of prospective residents and the wellbeing of the existing residents. All residents and prospective residents are provided with a copy of the homes Service Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: User Guide. The Statement of Purpose and Service User Guide was seen to be up-todate and is provided to each resident. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of residents, who are involved to the best of their capabilities in decision-making and self-determination. Evidence: The registered provider demonstrated a detailed understanding of the complex range of needs that are presented by residents and the records inspected detailed how the relevant support is provided. The registered provider is involved daily with the running of the home, she is available to residents and their families at all times. She is involved with the multidiciplinairy team and attends all meetings concerning residents. Residents each have an individual care plan, which sets out the goals of their placements in the home so that they maintain and develop their independence and are able to enjoy a good quality of life in a homely, community setting. They are encouraged to make decisions for themselves about things that are important to them, such as how to spend their money and what to wear. They are supported to take managed risks so that they develop their confidence and skills. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Care plans are regularly reviewed with the involvement of the person concerned. 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 residents weekday activities. Policies and procedures have been put in place to safeguard the people using the service. Written risk assessments are in place. 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. The people using the service make decisions on how they spend their time and they decide when to get up and go to bed and so on. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of social and recreational opportunity is available in keeping with known preferences and capabilities. Residents engage with the local community, and all have appropriate contact with people important to them. Residents rights and capacity as adults is recognised. A balanced diet is provided. Evidence: Evidence was provided in the form of documentation, records, observation, talking with the people using the service and registered provider. Activities take place in the home, and the residents go out on trips and into town and so on. Residents are involved in planning of their own daily life and activities. 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 Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: Social Care. Residents expressed satisfaction with these activities. Residents were satisfied with the leisure activities available and reported that they were able to participate in their preferred activities. Residents rooms demonstrated their interests, for example, in music, television, sports and playstation. The provider supports residents in attending local clubs. 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 registered provider does not act as appointee for any resident, though discussion took place in respect of arranging for one residents benefits to be paid direct to their own bank account. There is a choice available at every meal. Residents help with shopping and with planning the menu. They have access to snacks, hot and cold drinks. None of the current residents has any specific dietary needs. The kitchen and dining area were seen to be clean and pleasant at the time of the inspection. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is given to residents according to their needs, ensuring their individual preference is respected. Residents have access to health care services as necessary to ensure their physical and emotional needs are met. There is a suitable system in place for dealing with residents medicines. Evidence: Evidence was provided in the form of records, observation, talking with the people using the service, staff and registered provider. 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. Appropriate personal support, care and encouragement are provided in such a way as to respect residents privacy and dignity. Two residents share a bathroom, one having their own en-suite. The care records, observation, and discussion with the registered provider and residents show that the residents waking day is flexible. The residents are free to determine their own lifestyle. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: All residents are registered with a GP and specialist health care workers are consulted as necessary. One residents self-medicates. The registered provider has a written medication policy appropriate to the home. There are suitable storage facilities for medicines. The supplying pharmacist visits every 6-months to give advice and last attended on 23rd September 2008. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a suitable complaints procedure. Residents were seen to interact with the registered provider in a relaxed manner. The registered provider has a clear understanding of Adult Protection issues and procedures that will protect residents from abuse. Evidence: Evidence was provided in the form of documentation, observation, and talking to the registered provider. The people that live at Avalon are enabled to maintain existing contacts with relatives and friends, and external agencies. The homes complaints procedure is available to residents in the Service User Guide. The home has an appropriate policy and procedure regarding complaints and concerns. The Commission for Social Care Inspection has not received any complaints since the last inspection. 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. The registered provider has attended multi-agency training on protecting vulnerable adults from abuse. The home has copies of the local authority procedures for safeguarding vulnerable adults. All clients have some access to resources outside of the home so they are not isolated there. Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: The registered provider does not act as appointee for any resident. Care Homes for Adults (18-65 years) Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider continues to improve the environment for residents. The home is clean and free from offensive odours making it a pleasant place to live in. Evidence: Evidence was provided in the form of a tour of the building, observation, AQAA and discussion with the registered provider. The home provides a warm, comfortable, homely environment. It is clean, well furbished and free from odours. The home provides plentiful communal space and pleasant bedrooms, which are decorated with the involvement of the person living there. 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 was 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, plus an external barn used for exercising, darts, and pool. The three residents bedrooms are all single rooms. Residents reported that they were satisfied with the accommodation provided. They said that their bedrooms were comfortable and Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: provided the facilities they required. One bedroom has an en-suite shower, hand basin, and toilet. Two residents, who both have hand basins in their rooms, 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. There is a small office. 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 an area of decking. 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. Care Homes for Adults (18-65 years) Page 21 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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. The provider runs the home on a domestic scale and residents experience a pattern of living close to a family situation. The registered providers sister is available to provide short-term care in times of emergency. Residents are familiar with her, as she often visits the home, and there is documentary evidence that she is suitable to work with vulnerable adults in a care setting. Residents may also visit their families when the registered providers have a break. The registered provider has completed a range of training in order to undertake her role. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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 registered provider takes actions to ensure the safety and welfare of the residents. Evidence: Evidence was provided in the form of documentation, records, talking with the people using the service, and registered provider. 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, 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 were up-to-date and accurate at the time of the unannounced inspection. Residents are asked to complete a written questionnaire Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: twice yearly as part of the review of their care and the quality assurance process. The records demonstrate that the home is regularly checked and kept safe from the risk of fire and other hazards. The registered provider showed safety and maintenance records. 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. 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. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 More could be done to ensure that residents receive a receipt for all financial transactions. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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