Care Home: Avondale

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• 32 Beaumont Way

What the care home does well One person had been admitted to the home since the previous inspection. Avondale`s needs assessment proved to be a useful assessment tool. The person was visited three times at their previous care home, and spent time at Avondale, to help make a decision about moving. A close relative of the person felt fully involved in the assessment process. They said Avondale staff concentrated on how the person could be engaged and motivated. They saw the placement as a good move for their relative. Daily records showed how people were encouraged to make choices. For example, one person sometimes got up at 6:00 a.m. but sometimes chose to lie in to 10:30 a.m. A person explained he was not very hungry at teatime, because he had asked for a large cooked breakfast in the morning. A photographic record showed people were regularly involved in everyday activities, such as making beds and laundry tasks; and in particular activities and events, such as changes to the home environment. Interactions seen between staff and people in the home showed an emphasis on time and support for people to make decisions and express choices. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 6Care and support plans showed ways to recognise and encourage individuals` acceptable behaviours, and to discourage unwanted behaviours by nonconfrontational, low-key means. Observations showed staff worked in line with these plans, presenting people with consistent responses. Through the week, each person benefited from some regular day activities. Apart from these programmed activities, there was a general emphasis on staff from the home supporting people to access the local community. On the day of inspection, three people went out one-to-one with staff members to go to a park or go shopping, one for clothes for a special occasion. Others were out at external day activities. This left two people in the home, with one member of staff. Staff described this as a "normal day". There was a good atmosphere within the home, staff stimulating conversation and singing, and including those who did not communicate verbally. People were supported to have a breakfast of choice as they got up. The main meal of the day was taken at teatime, mainly as a communal meal in the dining room because people needed varying degrees of staff support to take meals. However, one person chose to have a meal in the sitting room, whilst watching television. Care and support plans identified people`s important relationships and how these could be sustained. Records and discussions showed that visitors were welcomed. Two visitors spoke of their ability to visit any time. There were records of liaison with a wide range of healthcare professionals. For one person there had been close work with an occupational therapist about optimum wheelchair use. For another, there had been psychiatric input, but the consultant had closed the work in the light of "improving skills...further adjustments following input from the speech and language therapist [and] improved diet and communication methods". A physiotherapist had also ceased working with the individual because of "satisfaction with learning and actions of Avondale staff". A community nurse for people with learning disabilities had worked a shift with home staff in order to understand and advise on a person`s discomfort in some personal care routines. She said the work done demonstrated that the home`s practice with the person was appropriate and was not the source of difficulties. Rotas showed there were always four care staff on duty during the day and evening. At night there were two waking staff. Staff and relatives that we spoke with considered the level of staffing to be appropriate to the needs of the home. The staff group showed diversity in a number of ways. There was a three-year training needs analysis, which showed when individual staff would have to renew the various components of mandatory training. Several staff had worked on distance learning courses, including medicationsand infection control. Special interest courses had been accessed, in palliative care and understanding epilepsy. Lea Wintle described ways in which he promoted communication with people living at Avondale, their supporters and the staff. He continued to exercise some care duties. He had been meeting informally but regularly with a number of relatives individually and there were examples of using their expertise. For example, a person told us they were able to influence decisions over meal provision on the basis of their background in catering. It was evident from talking to relatives at the home and by telephone, and from observing interactions, that they found it easy to engage with Lea Wintle and any of the staff. What has improved since the last inspection? At the random inspection in May 2007, a requirement was made to improve all care plans so that they were easily accessible and covered people`s needs in sufficient detail. At this inspection, that task had been completed. Each person had two care planning folders. One was a "personal portfolio", designed in "person centred" terms. These all began with guidance about communication needs, and went on to identify how people`s fulfilment and wellbeing would be promoted or undermined. Separate to this was a care and support plan that cross-referred to risk assessments, and gave specific guidance on how to provide care. Copies of these plans were kept in each person`s room. Two visitors said separately they had seen improvements in staff approaches to working with people during the past year. One said "staff routinely include the residents in everyday activity, and explain what they are doing". A relative commented in the survey, "More thought is now given to individual needs than before, when the resident had to fit into the mould that was there". For one person, a pattern of frequent trips to hospital had been curtailed by obtaining equipment similar to that available in the hospital. This was seen in use. There were clear guidelines to staff for use of the equipment. A relative of the person concerned was very satisfied with this response. At the random inspection in May 2007, a number of shortfalls were identified in medications practices in the home. Requirements were set to ensure improvements in practice. Our pharmacist inspector carried out a random inspection in September 2007 and found the requirements to have been met. This inspection has further confirmed that one member of staff has overall responsibility for the ordering, storage, monitoring and disposal of medications. On each shift, one person was clearly designated as key holder. Protocols for the use of "as needed" prescribed medicines and non-prescribed "homely" medications were in place, with evidence of GP agreement. There was evidence of investment in the premises. A requirement to make the outside patio area safer had been actioned in an imaginative way. It now formed part of a landscaped area that has transformed the attractiveness of the outside area. Facilities included a wheelchair-height planter and a safely located barbecue. There was good provision of shade by way of fixed parasols and awnings. A requirement to meet the National Minimum Standard for provision of bathrooms had been met by creation of a new wet room. The Parker bathroom had been redecorated so that it could be kept clean easily. The sitting room and dining room had been reconfigured and redecorated. People living in the home had chosen the colour schemes, soft furnishings and crockery. Staff and residents benefited from a newly designed office, which was suitable for wheelchair access. The hatch to the kitchen had been enlarged to improve communication with the dining room. The wet room was equipped with a special chair. New dining furniture had been provided. The laundry room was stocked with protective aprons and gloves, and guidance on their use, as required at the random inspection in May 2007. A member of staff was designated to monitor cleaning standards. The dining room had new flooring, which was easy to keep clean, and a carpet cleaner had recently been bought, to ensure carpeted areas could be cleaned to a high standard. There was certification that the home was free of legionella, with an annual re-test date set. This had been subject of requirement at the previous key inspection. Over 50% of staff had achieved National Vocational Qualifications (NVQ) in care, with others working towards this. This represented an improvement from the previous key inspection, when a requirement was made to achieve over 50% staff attainment of NVQ to at least level 2. At the random inspection in May 2007, staff were not receiving regular individual supervision. A requirement was made that they should have one-toone meetings at least six times a year. There was now a system in place for staff to receive six-weekly individual supervision from a project worker. Records showed this was consistent and of good quality, with individual staff receiving additional monitoring or support when necessary. A relative said the home had improved considerably in the past year because of positive staff attitudes, encouraged by the manager and senior care staff. A comment was, "They routinely include the residents in everyday activity. They explain what they are going to do." As a result, the person said they had seen clear benefits for their relative. What the care home could do better: For future assessments of prospective residents, a fuller record of observations and outcomes of visits, leading to a clearly recorded decision about the application, would help demonstrate how a final decision to admit or not, was reached. Daily notes kept by staff could have given more information about how specific support plan goals were approached or achieved. Better documentation wouldbe good evidence for reviews, or could trigger early reviews of care plans or risk assessments. One person was significantly younger than the majority in the home. There was scope for developing their care plan to show how age-specific social needs might be further developed and supported for them. Care and support plans gave guidance on the support people needed to eat and to maintain a healthy diet. A dietician`s advice had been obtained, both generally and for meeting the needs of two people in particular. However, a requirement to keep a record of all meals served had not yet been complied with. Where bed rails were in use there were risk assessments, but no evidence of external consultation and agreement on use of the rails; neither was the review frequency in line with Department of Health guidelines. CARE HOME ADULTS 18-65 Avondale 62 Stratford Road Salisbury Wiltshire SP1 3JN Lead Inspector Roy Gregory Unannounced Inspection 27th May 2008 10:00 Avondale DS0000015889.V360940.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 Avondale DS0000015889.V360940.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. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avondale Address 62 Stratford Road Salisbury Wiltshire SP1 3JN 01722 331312 01722 329668 lea.wintle@turning-point.co.uk, roger.mouncher@turning-point www.turning-point.co.uk Turning Point Limited 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) Mr Roger Mouncher Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of service users to be accommodated at any time must not exceed 12. The home must comply with the Residential Forum guidance on staffing levels for care homes for 12 service users with high needs. Staffing numbers must reflect the numbers and needs of service users in the home at any one time. A minimum of 5 staff must be on duty in the home when all service users are present. Due to the complex needs of the service users cared for in the home there must be at all times a member of staff who has received appropriate training in the following: PEG/PEJ feeds, suctioning administration of rectal stesolid, medication administration and safe use of oxygen. One named service user may be aged less than 18 years but over 16 years. For so long as condition 4 above applies, all staff must receive training in child protection and be subject to all statutory checks that apply to adults working with children. 12th September 2006 3. 4. 5. Date of last inspection Brief Description of the Service: Although registered to accommodate up to twelve people with a learning disability, Avondale has been reduced in size to a maximum capacity of eight people. This has been achieved by ceasing use of the first floor of the building and adding facilities to the single ground floor it now occupies, much of which is single storey in any case. People have single bedrooms, one of which has en suite facilities. There are adapted toilets close to bedrooms and to communal rooms, a Parker bathroom and a wet room. Corridors, the office and the shared sitting room and dining room are large enough to allow for easy passage of wheelchairs. The kitchen is not suitable for access by the people that live in the home, but has a large serving hatch to the dining room. Outside there is a safe patio and lawned area with garden furniture and provision of shade. The home is in a residential area with easy access by bus, road and footpath to Salisbury city centre and to the rural outskirts. There is limited parking on site and on-street parking nearby. The home is provided by Turning Point Ltd., which also provides other care services within the city of Salisbury. Next to the home is a day resource operated by Turning Point, which is used by some residents of the home. Some people use outreach services provided by Turning Point. Weekly fees currently payable ranged from £1075 to £1511, according to individually assessed needs. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We visited Avondale between 10:00 a.m. and 08:00 p.m. on Tuesday 27th May 2008. This allowed for meeting with all people currently living at the home, and with a number of staff. The manager, Lea Wintle, was available during most of the day. Two visitors to the home were interviewed in private. The inspector shared an evening meal with residents. All communal areas of the home and grounds were toured, and two bedrooms were seen. Records looked at included care plans, care and health records, medication records and evidence of monitoring hygiene and health and safety issues. Evidence of staff training delivered and planned was seen. There was an array of photographic evidence of people’s involvement in various aspects of life at the home. Prior to the inspection, survey questionnaires were sent out to people. Relatives or advocates of people living at the home returned four, and two had been completed by residents, with staff assistance. We also had the benefit of the home’s “annual quality assurance assessment”, which had been returned as required. A relative made contact by telephone. After the inspection we spoke to a community nurse for people with a learning disability, who is a regular visitor to the home. What the service does well: One person had been admitted to the home since the previous inspection. Avondale’s needs assessment proved to be a useful assessment tool. The person was visited three times at their previous care home, and spent time at Avondale, to help make a decision about moving. A close relative of the person felt fully involved in the assessment process. They said Avondale staff concentrated on how the person could be engaged and motivated. They saw the placement as a good move for their relative. Daily records showed how people were encouraged to make choices. For example, one person sometimes got up at 6:00 a.m. but sometimes chose to lie in to 10:30 a.m. A person explained he was not very hungry at teatime, because he had asked for a large cooked breakfast in the morning. A photographic record showed people were regularly involved in everyday activities, such as making beds and laundry tasks; and in particular activities and events, such as changes to the home environment. Interactions seen between staff and people in the home showed an emphasis on time and support for people to make decisions and express choices. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 6 Care and support plans showed ways to recognise and encourage individuals’ acceptable behaviours, and to discourage unwanted behaviours by nonconfrontational, low-key means. Observations showed staff worked in line with these plans, presenting people with consistent responses. Through the week, each person benefited from some regular day activities. Apart from these programmed activities, there was a general emphasis on staff from the home supporting people to access the local community. On the day of inspection, three people went out one-to-one with staff members to go to a park or go shopping, one for clothes for a special occasion. Others were out at external day activities. This left two people in the home, with one member of staff. Staff described this as a “normal day”. There was a good atmosphere within the home, staff stimulating conversation and singing, and including those who did not communicate verbally. People were supported to have a breakfast of choice as they got up. The main meal of the day was taken at teatime, mainly as a communal meal in the dining room because people needed varying degrees of staff support to take meals. However, one person chose to have a meal in the sitting room, whilst watching television. Care and support plans identified people’s important relationships and how these could be sustained. Records and discussions showed that visitors were welcomed. Two visitors spoke of their ability to visit any time. There were records of liaison with a wide range of healthcare professionals. For one person there had been close work with an occupational therapist about optimum wheelchair use. For another, there had been psychiatric input, but the consultant had closed the work in the light of “improving skills…further adjustments following input from the speech and language therapist [and] improved diet and communication methods”. A physiotherapist had also ceased working with the individual because of “satisfaction with learning and actions of Avondale staff”. A community nurse for people with learning disabilities had worked a shift with home staff in order to understand and advise on a person’s discomfort in some personal care routines. She said the work done demonstrated that the home’s practice with the person was appropriate and was not the source of difficulties. Rotas showed there were always four care staff on duty during the day and evening. At night there were two waking staff. Staff and relatives that we spoke with considered the level of staffing to be appropriate to the needs of the home. The staff group showed diversity in a number of ways. There was a three-year training needs analysis, which showed when individual staff would have to renew the various components of mandatory training. Several staff had worked on distance learning courses, including medications Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 7 and infection control. Special interest courses had been accessed, in palliative care and understanding epilepsy. Lea Wintle described ways in which he promoted communication with people living at Avondale, their supporters and the staff. He continued to exercise some care duties. He had been meeting informally but regularly with a number of relatives individually and there were examples of using their expertise. For example, a person told us they were able to influence decisions over meal provision on the basis of their background in catering. It was evident from talking to relatives at the home and by telephone, and from observing interactions, that they found it easy to engage with Lea Wintle and any of the staff. What has improved since the last inspection? At the random inspection in May 2007, a requirement was made to improve all care plans so that they were easily accessible and covered people’s needs in sufficient detail. At this inspection, that task had been completed. Each person had two care planning folders. One was a “personal portfolio”, designed in “person centred” terms. These all began with guidance about communication needs, and went on to identify how people’s fulfilment and wellbeing would be promoted or undermined. Separate to this was a care and support plan that cross-referred to risk assessments, and gave specific guidance on how to provide care. Copies of these plans were kept in each person’s room. Two visitors said separately they had seen improvements in staff approaches to working with people during the past year. One said “staff routinely include the residents in everyday activity, and explain what they are doing”. A relative commented in the survey, “More thought is now given to individual needs than before, when the resident had to fit into the mould that was there”. For one person, a pattern of frequent trips to hospital had been curtailed by obtaining equipment similar to that available in the hospital. This was seen in use. There were clear guidelines to staff for use of the equipment. A relative of the person concerned was very satisfied with this response. At the random inspection in May 2007, a number of shortfalls were identified in medications practices in the home. Requirements were set to ensure improvements in practice. Our pharmacist inspector carried out a random inspection in September 2007 and found the requirements to have been met. This inspection has further confirmed that one member of staff has overall responsibility for the ordering, storage, monitoring and disposal of medications. On each shift, one person was clearly designated as key holder. Protocols for the use of “as needed” prescribed medicines and non-prescribed “homely” medications were in place, with evidence of GP agreement. There was evidence of investment in the premises. A requirement to make the outside patio area safer had been actioned in an imaginative way. It now formed part of a landscaped area that has transformed the attractiveness of the outside area. Facilities included a wheelchair-height planter and a safely Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 8 located barbecue. There was good provision of shade by way of fixed parasols and awnings. A requirement to meet the National Minimum Standard for provision of bathrooms had been met by creation of a new wet room. The Parker bathroom had been redecorated so that it could be kept clean easily. The sitting room and dining room had been reconfigured and redecorated. People living in the home had chosen the colour schemes, soft furnishings and crockery. Staff and residents benefited from a newly designed office, which was suitable for wheelchair access. The hatch to the kitchen had been enlarged to improve communication with the dining room. The wet room was equipped with a special chair. New dining furniture had been provided. The laundry room was stocked with protective aprons and gloves, and guidance on their use, as required at the random inspection in May 2007. A member of staff was designated to monitor cleaning standards. The dining room had new flooring, which was easy to keep clean, and a carpet cleaner had recently been bought, to ensure carpeted areas could be cleaned to a high standard. There was certification that the home was free of legionella, with an annual re-test date set. This had been subject of requirement at the previous key inspection. Over 50 of staff had achieved National Vocational Qualifications (NVQ) in care, with others working towards this. This represented an improvement from the previous key inspection, when a requirement was made to achieve over 50 staff attainment of NVQ to at least level 2. At the random inspection in May 2007, staff were not receiving regular individual supervision. A requirement was made that they should have one-toone meetings at least six times a year. There was now a system in place for staff to receive six-weekly individual supervision from a project worker. Records showed this was consistent and of good quality, with individual staff receiving additional monitoring or support when necessary. A relative said the home had improved considerably in the past year because of positive staff attitudes, encouraged by the manager and senior care staff. A comment was, “They routinely include the residents in everyday activity. They explain what they are going to do.” As a result, the person said they had seen clear benefits for their relative. What they could do better: For future assessments of prospective residents, a fuller record of observations and outcomes of visits, leading to a clearly recorded decision about the application, would help demonstrate how a final decision to admit or not, was reached. Daily notes kept by staff could have given more information about how specific support plan goals were approached or achieved. Better documentation would Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 9 be good evidence for reviews, or could trigger early reviews of care plans or risk assessments. One person was significantly younger than the majority in the home. There was scope for developing their care plan to show how age-specific social needs might be further developed and supported for them. Care and support plans gave guidance on the support people needed to eat and to maintain a healthy diet. A dietician’s advice had been obtained, both generally and for meeting the needs of two people in particular. However, a requirement to keep a record of all meals served had not yet been complied with. Where bed rails were in use there were risk assessments, but no evidence of external consultation and agreement on use of the rails; neither was the review frequency in line with Department of Health guidelines. 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. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 10 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 Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 11 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. The admission process ensures that assessed needs will be met and the needs of existing service users taken into account. EVIDENCE: One person had been admitted to the home since the previous inspection. They had been visited three times at their former care home and had visited Avondale twice. Avondale’s needs assessment proved to be a useful assessment tool. It showed scores, under 34 different headings, of the person’s relative independence or dependency, to help determine the level of staff support they would require. All residents were periodically reassessed using this tool. The home’s assessment was used in conjunction with a review by the person’s care manager. The latter had assessed that an overnight trial stay was inappropriate to the needs of the individual. However, arrangements were made for a member of staff of the person’s previous placement to stay for their first night’s stay at Avondale, to assist a smooth transition. For future assessments of prospective residents, a fuller record of observations and outcomes of visits, leading to a clearly recorded decision about the application, would help demonstrate how a final decision to admit or not, was reached. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 12 A close relative of the most recently admitted person confirmed how the assessment and preparation process was conducted. They felt fully involved in the process. They commented that Avondale staff saw beyond some negative aspects of the previous care home’s assessment of the person, concentrating instead on how the person could be engaged and motivated. They considered the quality of assessment directly helped the person to settle into the home, and led into the initial care and support plan. As a result they saw the placement as a good move for their relative. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 13 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. People’s assessed needs are reflected in care and support plans. These are reviewed to reflect changes. People are supported in making decisions about their everyday lives. Risks are identified, and assessed in such a way as to encourage safe participation in a range of activities. EVIDENCE: At the random inspection in May 2007, care plans contained material that needed archiving, and were not easily accessible to staff, suggesting they were not documents that were in regular use. One care plan was in an improved format. There was a requirement made to improve all care plans so that they were easily accessible and covered people’s needs in sufficient detail. It was suggested that the new format of care plan be adopted for all. At this inspection, that task had been completed to a good standard. Each person had two care planning folders. One was a “personal portfolio”, designed in “person centred” terms. These all began with guidance about communication needs, and went on to identify how people’s fulfilment and wellbeing would be Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 14 promoted or undermined. Separate to this was a care and support plan, a copy of which was kept in the individual’s room as well as in the office. The care and support plan cross-referred to risk assessments, and gave specific guidance on how to provide care. There was evidence of reviews of plans, so goals agreed with people were followed up. Staff spoke of one person’s development of abilities to eat meals with less support, and to spend more time on their feet rather than in a wheelchair. However, daily notes kept by staff could have given more information about how specific support plan goals were approached or achieved, as documentary evidence for reviews. This might also trigger early reviews of risk assessments. In the example given above, risk assessments were still based on the person’s abilities when the support plan was started. There was photographic and other evidence to show that people were actively involved in developing their personal portfolios. For example, people chose what pictures they wanted to illustrate them, by being supported to select from the computer. The portfolios were presented in a narrative first person form. One danger of this was that sometimes, assumptions appeared to be made by the writer; for example, “I think I am very lucky as I do lots of activities”. Daily records were good at showing how people made and were encouraged to make choices. For example, the record for one person showed they sometimes got up at 6:00 a.m. and sometimes chose to lie in to 10:30 a.m. A person explained he was not very hungry at teatime, because he had asked for a large cooked breakfast in the morning. The daily record confirmed this. A photographic record showed people were regularly involved in everyday activities, such as making beds and laundry tasks; and in particular activities and events, such as changes to the home environment. Interactions seen between staff and people in the home showed an emphasis on time and support for people to make decisions and express choices. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 15 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. People are supported to maintain their chosen lifestyles and social interests. They have good access to the locality. Relationships with families and friends are encouraged. Mealtimes are conducted in a way that meets individual needs, but the nature of diet offered is not recorded. EVIDENCE: A “daily schedule” showed that through the week, each person benefited from some regular day activities. These included the “Focus Point” day resource next door, a day resource for older people, and a local authority day centre. One person was still in full time education, and Lea Wintle was involved in liaison about the person’s future occupational needs. Some people went out with Turning Point outreach workers. For example, a person had recently been supported to maintain their interest in steam railways by going to ride on one. Apart from these programmed activities, Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 16 there was a general emphasis on staff from the home supporting people to access the local community as a key component of care. On the day of inspection, three people went out one-to-one with staff members to go to a park or go shopping, one for clothes for a special occasion. Others were out at external day activities. This left two people in the home, with one member of staff. Staff described this as a “normal day”. Daily records showed this was so. For one person, for example, recent entries showed they had been shopping, been on a trip to the seaside, been for local walks and had a picnic. The home had a minibus, so small groups could go out to places such as the New Forest. One person was about to go on holiday to Euro Disney with a member of staff, which a relative said would be a significant “first” for the person. There was a television and DVD player in the sitting room, which were used purposefully as people wanted, whilst people also had audio-visual equipment in their rooms. There was evidence of encouragement to maintain particular interests. There was a good atmosphere within the home, staff stimulating conversation and singing, and including those who did not communicate verbally. In one person’s personal portfolio, an entry read, “staff support me to keep my room tidy. We make this fun as we play music when we are tidying up.” Their care plan described how staff should provide support to tasks such as laundry, making the bed and putting clothes away. Care and support plans identified people’s important relationships and how these could be sustained. Records and discussions showed that visitors were welcomed. Two visitors spoke of their ability to visit any time. Both said they had seen improvements in staff approaches to working with people during the past year. One said “staff routinely include the residents in everyday activity, and explain what they are doing”. For example, there had been a makeover of the outside space, and people had been involved in decisions about design and where to put things. Each resident had been invited to paint a flowerpot in their own way and to plant it, to promote a sense of ownership. Some relatives had also got involved in this. One person’s personal portfolio identified church attendance as significant to them, and how this was to be facilitated. One person was significantly younger than the majority in the home. There was scope for developing their care plan to show how age-specific social needs might be further developed and supported for them. The home’s kitchen was a commercial rather than domestic design, and was risk-assessed as unsuited to access by people that live in the home. A person in a survey return indicated one resident of the home who would like the chance to be more involved in cooking. The serving hatch to the dining room had been enlarged, so people could see food preparation taking place. One person particularly liked to do this. People were supported to have a breakfast of choice as they got up. The main meal of the day was taken at teatime, mainly as a communal meal in the dining room because people needed varying degrees of staff support to take meals. However, one person chose to have a Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 17 meal in the sitting room, whilst watching television. In good weather, some meals were taken outside. Care and support plans gave guidance on the support people needed to eat and maintain a healthy diet. A dietician’s advice had been obtained, both generally and for meeting the needs of two people in particular. It was a help to the home that on changing from having a designated cook, to incorporating cooking as a care duty, the former cook took on a care role and thus remained a resource to the home. Two relatives spoke of their original concerns about changes to catering provision having been allayed by the actual experience of the past year. People living at the home were sometimes involved in food shopping, and some vegetables had been planted. However, a requirement from the random inspection for keeping a record of all meals served had not yet been complied with. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 18 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. The home provides personal support in line with people’s preferences and needs. There are good links and systems to ensure physical and emotional health needs are met. People are protected by the home’s medication procedures. EVIDENCE: Support plans that we looked at contained specific guidance to how people liked to receive personal care. For a person with a visual impairment, the nature of their difficulties was explained in their support plan. There was evidence of having obtained advice from the RNIB. There were also examples of identified indicators by which staff could recognise the person was in pain or feeling unwell. There was a risk assessment concerning the person’s emotional wellbeing. This in turn was linked to a behaviour management strategy, and cross-referred to a protocol for use of a medication prescribed for use “as needed”. There were records of liaison with a wide range of healthcare professionals. For one person there had been close work with an occupational therapist about Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 19 optimum wheelchair use. For another, there had been psychiatric input, but the consultant had closed the work in the light of “improving skills…further adjustments following input from the speech and language therapist [and] improved diet and communication methods”. A physiotherapist had also ceased working with the individual because of “satisfaction with learning and actions of Avondale staff”. People had health action plans and, where appropriate, epilepsy profiles. Where an individual needed monitoring of fluid and food intake, to inform review by a nutritionist, this appeared to be undertaken consistently and accurately. The care and support plan contained clear guidance from the nutritionist, including use of PEG feeding. The person’s weight was increasing as planned; however, the care plan demanded weekly weighing, and that frequency was not being achieved. A community nurse for people with learning disabilities had worked a shift with home staff in order to understand and advise on a person’s discomfort in some personal care routines. The nurse confirmed to us that the request for help was a proactive decision on the part of the home. She considered the work done demonstrated that the home’s practice with the person was appropriate and was not the source of difficulties. The nurse had carried out a nursing assessment on another person in Avondale to ensure all agencies working with the person were offering consistent care and recognising all needs. Again, she had no concerns about the approach of Avondale staff. As a relatively frequent visitor to the home, the nurse was complimentary of the nature of working relationships demonstrated by staff towards both residents and visiting professionals. She also confirmed provision of training concerning suction and epilepsy, in respect of which there were certificates on staff files. She appreciated assistance the home had given towards training arrangements for a student nurse. For one person, a pattern of frequent trips to hospital had been curtailed by obtaining equipment to mirror that available in A&E departments. This was seen in use. There were clear guidelines to staff, for recognising the onset of a problem, and for use of the equipment. A relative of the person concerned was very satisfied with this response, and had been involved in identifying a supply source for the equipment and agreeing the terms of use. At the random inspection in May 2007, a number of shortfalls were identified in medications practices in the home. Requirements were set to ensure improvements in practice. Our pharmacist inspector carried out a random inspection in September 2007 to assess compliance with the requirements and found them to have been met. This inspection has further confirmed that one member of staff has overall responsibility for the ordering, storage, monitoring and disposal of medications. On each shift, one person was clearly designated as key holder. Protocols for the use of “as needed” prescribed medicines and non-prescribed “homely” medications were in place, with evidence of GP Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 20 agreement. An example seen of use of an “as needed” medicine reflected the written protocol. The reverse side of the Medicines Administration Record (MAR) chart showed the circumstances of use. The MAR charts were in good order and there were systems in place to monitor them. There was evidence on staff files of training in the administration of medicines, and in the monitored dosage system used by the supplying pharmacist. There had been specific external training in the use of two emergency rescue medications that were prescribed for some people in the home. Written guidance to the use of rescue medications was clear and readily accessible. In common with many care homes, Avondale needs to install controlled drug storage that meets new British Standards. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. EVIDENCE: Two complaints had been recorded since the previous inspection, both from relatives of people living in the home. Each resulted in a letter of apology, acknowledging that the home had fallen short of expected standards and with undertakings of action to ensure no recurrence. A number of complimentary letters had been received during the same period. It was clear from observations of interaction between manager and staff, and visitors to the home, and from discussions with relatives and other visitors, that the home had a culture of openness, in which criticism was seen as constructive and to be worked with. People gave examples of issues they had raised, which had been discussed and acted upon. Residents’ meetings, held every two months, were used in part to review things individuals had done, to help form a view of what people had experienced as helpful or difficult. Staff members were attending safeguarding training sessions provided by the Police Vulnerable Adults Unit, five having attended the previous week. There were examples from the previous year of the home’s co-operation with local inter-agency adult protection procedures, including initiation of referrals. A member of staff was suspended in response to complaints about their behaviour towards people in the home, raised by colleagues “whistle blowing”. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 22 The person has subsequently been dismissed, and referred by Turning Point for consideration of being placed on the POVA (Protection of Vulnerable Adults) list. There was evidence of staff training about the Mental Capacity Act, in which a written assessment had to be completed. An independent mental capacity advocate (IMCA) had been arranged recently to support a person in a question of consent to a medical investigation. One person was being visited regularly by an advocate, who completed a survey return on their behalf. All staff undertook mandatory breakaway training as a component in being able to work with a variety of behaviours that people could present. Care and support plans showed ways to recognise and encourage individuals’ acceptable behaviours, and to discourage unwanted behaviours by non-confrontational, low-key means. Observations showed staff worked in line with these plans, presenting people with consistent responses. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 23 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, 25, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a homely environment, maintained and kept clean to a high standard. Advice about equipment needed is sought and acted upon. EVIDENCE: There had been a change of social landlord since the previous inspection, and there was evidence of investment in the premises. A requirement to make the outside patio area safer had been actioned in an imaginative way. It now benefited from a non-slip, even surface, and formed part of a landscaped area that has transformed the attractiveness of the outside area. Facilities included a wheelchair-height planter and a safely located barbecue. There was good provision of shade by way of fixed parasols and awnings. Indoors, a requirement to meet the National Minimum Standard for provision of bathrooms had been met by creation of a new wet room. The Parker bathroom had been redecorated so that it could be kept clean easily. The sitting room and dining room had been reconfigured and redecorated. There Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 24 was evidence that the colour schemes, soft furnishings and crockery had been chosen by people living in the home. In a survey return, a relative wrote, “the staff are working as a team…and even redecorated the two main rooms, partly in their own time”. Staff and residents benefited from a newly designed office, which was suitable for wheelchair access and lent itself to efficient storage of documents and IT equipment. All together, a more homely feel had been achieved in the communal rooms. Two bedrooms were seen and each was very personalised, including that of the most recently admitted person. A new electric hoist had been purchased, with separate slings for individuals. In the dining room there was a board for showing the photographs of staff due on the next shift. The hatch to the kitchen had been enlarged to improve communication and vision between the two rooms. The wet room was equipped with a special chair. New dining furniture had been provided, some chairs being fitted with a device to make it easier for staff to move people closer to or further from the table. Environmental advice had been sought for meeting the needs of a person with visual deficits. All parts of the home presented as clean and fresh, including the laundry room. This was stocked with protective aprons and gloves, and guidance on their use, as required at the random inspection in May 2007. A member of staff was designated to monitor cleaning standards. There were schedules for ensuring all parts of the home were cleaned at an appropriate frequency. Much of the routine cleaning was the responsibility of night staff, but some cleaning tasks took place by day while people were out, or to involve people in domestic tasks. The dining room had new flooring, which was easy to keep clean. A heavy duty carpet cleaner had recently been bought, to ensure carpeted areas could be cleaned to a high standard. There was evidence that the new housing provider had attended to identified risk areas in the hot water system. There was certification that the home was free of legionella, with an annual re-test date set. This had been subject of requirement at the previous key inspection. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 25 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 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by competent, trained staff, who experience regular supervision and are supported by an employer committed to staff development. Recruitment practices ensure people are protected from being cared for by unsuitable staff. EVIDENCE: With the reduction in size of the service, some former staff had transferred with former residents to a new service. During 2007, there was a period of poor staff retention, mainly due to people moving away or progressing in their careers. Therefore there remained some reliance on agency staffing, but rotas showed that agencies have been able to supply consistent staff. Three agency staff were about to transfer to Avondale’s staff. Rotas showed there were always four care staff on duty during the day and evening. At night there were two waking staff, who carried out routine safety checks, any care duties arising, and cleaning tasks. Staff and relatives that we spoke with considered the level of staffing to be appropriate to the needs of the home. The staff group included both men and women, and there was some ethnic diversity. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 26 Turning Point expects all care staff to attain National Vocational Qualifications (NVQ) to level 3. Well over 50 of Avondale staff had achieved this, with others working towards it. This represented an improvement from the previous key inspection, when a requirement was made to achieve over 50 staff attainment of NVQ to at least level 2. Newly recruited staff undertake an induction compliant with recognised “core induction standards”, which includes gaining the Learning Disabilities Qualification (LDQ). A respondent to the relatives’ survey wrote, “New staff are quickly involved in training and instructions”. There was a three-year training needs analysis, which showed when individual staff would have to renew the various components of mandatory training. Several staff had worked on distance learning courses, including medications and infection control. Special interest courses had been accessed, in palliative care and understanding epilepsy. There were arrangements with external nurses for delivery and certification of training in specialist techniques relevant to the home, including suction and PEG feeding, so that such tasks would always be undertaken by staff with the necessary competence. CSCI has an arrangement with Turning Point whereby standards of recruitment are checked centrally rather than at individual inspections. This ensures people that are recruited are subject to essential vetting procedures, so that they are safe to work with vulnerable people. In answer to “what does the care home do well?” a relative commented in a survey, “They employ reliable staff”. Another wrote, “Avondale is a safer place than some years ago…we are aware this depends on those staff, who are totally dedicated”. All respondents wished to see ongoing recruitment, to lessen reliance on agency staff or on staff overtime, in order to promote consistency of care and training. At the random inspection in May 2007, staff were not receiving regular individual supervision and a requirement was made that they should have oneto-one meetings at least six times a year. There was now a system in place for staff to receive six-weekly individual supervision from a project worker. Records of supervision meetings showed they were used to help members of staff reflect on the impact of their work, and of training they had received, on the people who live in the home. Supervision also covered operational needs of the home, and support to staff members to address any difficulties or training needs. For example, an issue raised with one person led to a period of agreed monitoring, along with discussion about the causes of the identified problem. The project worker said the company’s appraisal and personal development programme proved to be an effective tool. Using this in supervision meetings had enabled formation of action plans as a means of supporting individuals. One person was receiving weekly support dedicated to completion of their NVQ. Night staff received supervision on an equal basis. A relative said the home had improved considerably in the past year because of positive staff attitudes, encouraged by the manager and senior care staff. A Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 27 comment was, “They routinely include the residents in everyday activity. They explain what they are going to do.” As a result, the person said they had seen clear benefits for their relative. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 28 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. Management provide leadership and direction so people benefit from a well run home. The views of service users’ and their supporters are obtained to monitor and improve the service. There are systems in place to identify and promote people’s health and safety needs, but safeguards in the use of bed rails were lacking. EVIDENCE: The registered manager for the service, Roger Mouncher, has taken a more senior role in the organisation, but retains a line management responsibility to Lea Wintle, who exercises day-to-day management of the service. Lea Wintle’s application to be registered has been received by CSCI. A close relative of a person who lives at Avondale described Lea Wintle as “an exceptional man” for his commitment to the wellbeing of residents and the efficient running of the home. Another person’s relative spoke in similar terms: “He is always Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 29 approachable and receptive to ideas and opinions”. A community nurse said that after a difficult period when the service was first reduced in size and carer roles changed, the home had “found its identity” and the staff group appeared united in commitment to develop the home positively. Lea Wintle described ways in which he promoted communication with people living at Avondale, their supporters and the staff. He continued to exercise some care duties. He had been meeting informally but regularly with a number of relatives individually and there were examples of using their expertise. For example, a person told us they were able to influence decisions over meal provision on the basis of their background in catering. It was evident from talking to relatives at the home and by telephone, and from observing interactions, that they found it easy to engage with Lea Wintle and any of the staff. Resident meetings were held two-monthly, whilst conversation and inclusion were evident throughout the day. Lea Wintle said people had indicated they wanted more attention to be paid to holiday arrangements, which had been taken on board. There was work in progress on a feedback system for gathering satisfaction ratings from people who live in the home. All relatives had been consulted about the restructuring of the home in 2007, and had been asked more recently on views about how the kitchen might be redeveloped. Staff meetings were programmed through the year. A recent one had an agenda of operational and care delivery issues. Combined with the individual supervision and appraisal arrangements, this meant staff could raise matters, whilst management expectations were clearly cascaded to the staff group. There were recorded monthly visits by higher management as a further check on quality of service. These led to action plans when shortfalls or areas for development were identified. Most individual members of staff were designated to oversee a particular aspect of service provision, such as medication practice, health and safety, housekeeping standards, first aid supplies and fire precautions. This ensured monitoring systems were upheld. Night staff monitored fridge temperatures, and were responsible for cleaning and checking the safety of wheelchairs. Staff records showed evidence of staff training in health and safety, moving and handling, first aid, fire safety, food hygiene and use of rescue medications. There was an appropriate spread of environmental risk assessments that were kept up to date. For example, the wet room was subject of a risk assessment before coming into use. A recent risk assessment about garden access put an emphasis on encouraging use of the garden, rather than restriction, as a primary aim. For individual wheelchair users, support plans showed how to achieve safe use of their equipment. Where bed rails were in use, however, although there were Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 30 risk assessments, there was no evidence of external consultation and agreement on use of the rails; neither was the review frequency in line with Department of Health guidelines. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 31 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 3 25 3 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 4 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 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 32 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 YA17 Regulation 17 (2) (sched 4 (13) 13 (2) Requirement There must be a full record of meals served. (Restated: The timescale for action was 06/09/07) All controlled drugs must be stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007) The use of bed rails must be assessed and documented in line with Department of Health guidelines. Timescale for action 27/05/08 2. YA20 01/09/08 3. YA42 13 (4)(c) 01/07/08 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 YA2 Good Practice Recommendations Assessments of prospective service users should reflect the experience of trial visits, and should culminate in a written and signed decision that a place is to be offered or not. DS0000015889.V360940.R01.S.doc Version 5.2 Page 33 Avondale 2. YA6 YA9 3. 4. 5. YA7 YA12 YA19 Care records should demonstrate that care and support have been given in line with care and support plans, and record where plans and risk assessments may be in need of early review. Guard against subjective assumptions when writing on behalf of service users. For younger service users, ensure plans for activities at home and in the community reflect their generational needs. Ensure assessed weighing frequencies are maintained, or re-assess the frequency with relevant professionals. Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West 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 Avondale DS0000015889.V360940.R01.S.doc Version 5.2 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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