Care Home: Avalon House

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What the care home does well The home employs a staff team that has a good knowledge and understanding of the needs of the service users and that work well as a team. The home is well situated to access community facilities central location. The home supports service users with individual programmes that involve time spent in the community and in the home. What has improved since the last inspection? A new care planning system is being implemented which will improve person centred planning and provide additional guidance and information for staff. The new Provider has taken over the role of co-ordinating staff training, which should bring benefits for the development of new and existing staff. What the care home could do better: There is a need to improve the physical environment of the home in certain areas. The bathroom is in particular need of refurbishment. The home should improve the location and quality of the medication storage cupboard. CARE HOME ADULTS 18-65 Avalon House 3 King Street Cheltenham Gloucester Glos GL50 4AU Lead Inspector Mr Simon Massey Key Unannounced Inspection 21st & 23rd November 2007 10:30 Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avalon House Address 3 King Street Cheltenham Gloucester Glos GL50 4AU 01242 582559 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) www.caretech-uk.com CareTech Community Services Ltd Mr Adam Jones Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 3. Date of last inspection Brief Description of the Service: Avalon House provides care, support and accommodation for three adults with learning disabilities. The home specialises in meeting the needs of adults who have an autistic spectrum disorder. The home has recently been purchased from the previous owner by Caretech Community Services. The home is located near to the centre of Cheltenham and is in walking distance of local shops and amenities. The home is a semi-detached property, with three upstairs bedrooms and a secure garden area to the rear. The current fee range was not available at the time of inspection. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. The Inspector met with the Registered Manager, several members of the care staff and all of the service users. Records relating to care planning, staff training and recruitment, health and safety and medication were examined. An inspection of the environment was also carried out. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: What has improved since the last inspection? What they could do better: There is a need to improve the physical environment of the home in certain areas. The bathroom is in particular need of refurbishment. The home should improve the location and quality of the medication storage cupboard. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies ensure that all prospective service users are assessed prior to admission to ensure their needs can be met. EVIDENCE: The new ownership of the home has resulted in several changes, one of which is move away from the previous philosophy of care at the home, outlined in their Statement of Purpose, and titled “Gentle Teaching”. There is a need to produce an updated Statement of Purpose that reflects these changes and the new practices that are being put in place. The home has had no admissions for several years and there are no plans currently for people to move on thus creating a vacancy. Records show that detailed information was collected on the service users prior to admission and that plans were put in place to meet the identified needs. The home does have an admissions policy in place, which meets the standard, but the home will be adopting the policy and procedure of the new Provider for any future admissions. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of service users are met through personalised routines that are supported by care plans, which are regularly reviewed. EVIDENCE: All service users have care plans in place that have been reviewed and updated where necessary. Two service users have also had placement reviews involving the placing authorities. The home is in the process of introducing a new care planning system, which will involve the Manager meeting with the individual key-workers on a monthly basis. A new format for recording needs and guidance is being introduced over the coming months. This will provide greater written detail and cover all aspects of the care and support that is provided. The existing plans contain information about all aspects of care and guidance on how needs should be met. The plans contain information about likes and dislikes, personal care requirements, how a service user may complain about Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 10 something they are not happy about and what domestic chores they are able or interested in completing. Each person has a “communication passport” which gives information about behavioural support, potential behavioural triggers and the low arousals approach that is required. The home operates a “traffic light” system in relation to behaviour, with staff recording against certain criteria. A selection of risk assessments were seen and it is noted that a number of these require reviewing and possibly updating. A new system of recording has been introduced and this appears to be working well. Good regular recording was seen in relation to activities, behaviours, health appointments and communication with families and relatives. Good records are also kept in regard to personal care and hygiene. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have been given increased opportunities to take part in activities in the community and the surrounding area. Service users are benefiting from a more planned approach towards vocational occupations. EVIDENCE: The staff team have increased the number and variety of activities being supported over the past few months and staff commented that this had been benefit to the service users. More emphasis has been placed on activities away from the home. Staff demonstrated a good awareness of the needs of the service users when planning and organising trips out, or different experiences for the service users. Staff were positive about these changes and whilst acknowledging it can be difficult to source activities that are enjoyed by the service users staff, were committed to ensuring that people had meaningful occupation as often as possible during the day and at weekends. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 12 Staff explained how they tried to encourage choice and decision making through understanding of individual needs, and staff were observed treating service users in a positive and respectful manner. There was evidence that the home supports people to maintain family contact with phone calls and visits, and feedback received from relatives was positive about the communication and liaison with the staff in the home. The home was well stocked with fresh and packaged food and guidance was in place relating to special dietary needs and preferences. Staff spoken to stated that the food was of a good standard, with sufficient quality and variety available. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal and healthcare needs are met, promoting their dignity and wellbeing. EVIDENCE: One service user who is administered medication has had this reviewed and changes have been recorded and implemented. The Manager described how the home are attempting to improve their links and liaison with the local Community Learning Disabilities Team. There have been regular meetings to discuss behaviours and medication. The Community Nurse is being involved to support the undertaking of health checks. The home has introduced a new system of recording injuries using body charts. These help the staff to monitor any self-injuries and record information appropriately. The home has begun completing “Health Action Plans” for all the service users and it is intended that these will be completed within the next two months. The home are also now able to use a Behavioural Management Consultant provided by CareTech, which will provide advice and guidance to the staff in the managing of any issue relating to service user behaviours. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 14 All staff will also be undertaking the accredited Studio Three training in the managing of challenging behaviours. The medication cabinet is incorrectly located and needs to be moved to a more secure area. The cabinet is also made of wood and does not close securely enough. This needs to be replaced or repaired. All medication was correctly recorded and administered at the time of this inspection. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory arrangements and procedures in place for the protection of service users and provides a safe environment for service users in which they are respected and treated with dignity. EVIDENCE: The service user’s finances are managed by the staff and the Manager, with records and receipts being kept in the home and then transferred to the main office on a regular basis. A sample of these finance were checked during this inspection and found to be in order. A record is kept in each plan of how a service user expresses their dislike or if they are unhappy about something. The home also has a complaints procedure that has been produced in symbol form. Relative’s spoken to were aware of how to raise a concern and felt able to approach the Manager or staff with any issue or concern that arose but were a little unclear about the formal complaint procedure that is in place. The Manager explained that it was the home’s intention to provide clarity to the relatives over this process. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable and homely but work is required to be undertaken in certain areas of the house to improve the physical environment. EVIDENCE: All the service users have individual rooms and these are personalised according to taste and need. Two service users appeared to express satisfaction with their accommodation and people were observed during this inspection using their rooms, as well as the rest of the accommodation. Whilst the individual rooms were well decorated and maintained other areas of the home require attention. At the time of this visit the kitchen ceiling had partially collapsed due to a leaking water pipe and was due to be repaired at the weekend. There were also plans to improve the lighting in the kitchen when this repair was completed. The entrance hallway is fitted with stone tiles and these appear to be worn and in a poor state of repair. The stairway has been fitted with lino but this appears Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 17 to have not been installed correctly, with various steps splitting creating a potential tripping hazard. The stairs also have several banisters missing, which present a further hazard The upstairs bathroom and adjoining toilet are in a very poor condition, with damp and mould present and poor tiling, which is difficult to keep clean. The replacement of the fittings and redecoration is now urgently required. One of the service user bedrooms has a very uneven floor and it was explained that this is being addressed. There has been an informal concern expressed by a neighbour about the noise caused by the repeated opening and shutting of doors by one of the service users. A potential solution to this is the installation of door dampeners and it is recommended that this investigated by the home. Action is required in respect of all of the above. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by staff that are well trained, relate well to them and have a positive approach to their care and support. Staff should benefit from the new Provider’s centralised system to the organising of staff training. EVIDENCE: The home currently is fully staffed and has only employed one new staff member in recent months. New staff are following a new form of induction brought in by the Provider, which ensures a full induction, with staff mentoring taking place. On completion of this staff undertake a six-month foundation course, using the Learning Disability Awards Framework. A sample of staff records were seen and these were up to date and contained all the required checks. CareTech have agreed with the Commission for staffing records to be kept centrally, with only the basic information being kept in the home. All staff are receiving regular formal supervision from the Manager and staff spoken to say they felt well supported and that people worked well as team Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 19 with good communication and support between members. Staff have also received annual appraisals. The majority of staff are up to date with the required statutory training and all updates will be completed by February 2008. All staff are undertaking “Studio Three” training in the managing of Challenging Behaviour. The majority of staff have completed NVQ2 or above. In the future it was explained that staff training will be monitored and co-ordinated centrally by the Provider. Further training is to be provided in Health and Safety, Fire Safety, Food Hygiene, First Aid and Medication Administration. The staffing rotas showed that the correct staffing levels are maintained and that sufficient staffing is provided when it is needed. There has been relatively low levels of sickness over the past twelve months. There is a need to provide clear written guidance on the combination of service users and the staffing ratios required to support trips into the community. This should be risk assessed and clear guidance provided to the staff. Certain combinations of service user apparently require different levels of staffing and this needs to be documented. Staff were observed working positively and comfortably with the service users and people were able to demonstrate a good understanding of the individual needs of the service users. There was evidence of regular and professional recording being completed and of staff encouraging choice and decision making by the service users. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well managed and organised and a management that is committed to providing good quality care and support. Improved systems of quality assurance and support for the management have been put into place that should help to monitor and improve the quality of the service. EVIDENCE: The Manager has received regular supervision from their line manager and regular Regulation 26 inspections have been completed. The Manager stated that they were being well supported through the period of change and being provided with advice and guidance. The home will be using the new Providers Quality Assurance team to undertake this form of review. The Manager explained that this was a comprehensive Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 21 system that should provide clear feedback and action points for the home. This will be done on an annual basis. Caretech have introduced their own set of policies and procedures for the home and the Manager and staff are gradually familiarising themselves with these. The home has a Fire Risk Assessment in place but in the opinion of the Inspector this needs to be reviewed and updated. This should include details of fire safety training undertaken and record of any evacuations that have occurred and documenting any problems. All fire safety equipment had been serviced and checked and all maintenance and fire testing had been completed and recorded. All potentially hazardous substances were correctly and safety stored and with the exception of the issues outlined under the environment standards, the home promotes a safe and reasonably maintained environment. The home is starting a new system of Health and safety auditing that is part of the policy of CareTech. This will involve a monthly recorded check on all aspects of the environment. Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 x X 3 X Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 2 3 4 Standard YA1 YA9 YA20 YA24 Regulation 4 Requirement Timescale for action 28/02/08 28/02/08 28/02/08 30/03/08 5 YA31 The home must produce an updated Statement of Purpose 17(3)(a) The home must ensure that risk assessments are reviewed and dated 13(2) The home must ensure that medication is correctly and securely stored 23(2)(b) (d) The home must address the following issues in relation to the environment. • Repair kitchen ceiling • Replace upstairs bathroom • Repair banisters • Repair and refit stair lino • Improve flooring area in hallway 12(1)(a)&13(4)(b) The home must provide guidance on the staffing ratios required to support service users in the community 28/02/08 Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 24 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 YA42 Good Practice Recommendations The home should review its fire safety assessment to ensure it includes all the required information Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Regional Contact Team Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Avalon House DS0000070598.V355406.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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