We carried out a review of the data available to us about 1 Devonshire Avenue on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about 1 Devonshire Avenue, you can give feedback on this service.
1 Devonshire Avenue is a 'care home' registered for 20 autistic people and people with a learning disability. There were 18 people living at the service at the time of our inspection. The service is provided on 1 site and consists of 2 different buildings.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
People’s experience of using this service and what we found.
Right Support
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff supported people to access health and social care services. People were supported to take their medicines in a safe way.
Right Care
Staff understood how to safeguard people from abuse and avoidable harm. People received care that was person-centred, and dignity and privacy was promoted. People received kind and compassionate care. Staff understood how to meet people’s needs and responded to people in a timely manner. People’s care plans reflected their needs and wishes. People’s wellbeing was promoted and risks were managed.
Right Culture
The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
People and those important to them, including healthcare professionals were involved in planning their care. The registered manager and staff team ensured people received support based on the values set out by the provider. These included Inspiration, Innovation, inclusive, integrity and impact.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 14 February 2019).
Why we inspected.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
This inspection was prompted by a review of the information we held about this service.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
1 Devonshire Avenue is a ‘care home’. Care is provided for younger adults with learning and physical disabilities across two separate houses, for a maximum of 20 people. At the time of our inspection18 people were using the service. The two houses both have a kitchen and large communal areas for people to spend time in. Both houses share an outside space with seating.
We found the following examples of good practice.
¿ Visitors had their temperature taken and were asked about their health. Hand washing facilities were accessible, hand sanitiser and masks were provided. Information was displayed about social distancing and handwashing techniques.
¿ Staff were provided with the appropriate personal protective equipment [PPE]. Fit testing had been carried out to ensure they were suitable for staff. Posters were displayed to remind staff how to put on and take off their PPE. Additional clinical waste bins had been purchased to dispose of PPE safely.
¿ The registered manager had registered for ‘whole house testing’ for people living at the service permanently and staff and they were waiting for this to commence.
¿ Families were kept updated about changes within the service. Relatives remained involved in people’s care. People stayed in contact with their families by phone, video calls and window visits to prevent isolation and promote people’s mental wellbeing.
¿ Risk assessments were carried out to assess the impact of Covid 19 on people and staff. Actions were taken to reduce the risks to people where necessary.
¿ Guidance on cleaning products was sought from the infection prevention and control team. The cleaning of touch points such as door handles, keyboards, phones, taps and switches had been increased and documented.
¿ The registered manager undertook contingency planning in case there was a future outbreak of Covid 19. For example, extra bank staff were employed to cover potential staff absences.
¿ Respite care was provided to people who were not symptomatic. Anyone staying for respite was required to isolate in their bedroom and stayed for a maximum of two nights.
Further information is in the detailed findings below.
At our last inspection on 1 June 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
The service operated in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Procedures were in place to ensure people were safe from harm. People had personalised risk assessments which were up to date. Staff members had received training in safeguarding adults from abuse and understood their roles and responsibilities in ensuring that people were safe.
People's medicines were managed safely. They were stored and administered appropriately. Accurate records were made when medicines were given. Staff members were qualified or had received training in the safe administration of medicines.
People had personalised care plans in place which were reviewed regularly and updated to reflect any change in a person’s needs. People's care plans and risk assessments included guidance for staff on supporting people's communication needs.
There were sufficient staff with the correct skill mix on duty to support people with their required needs. Effective recruitment processes were in place and followed by the registered manager. Staff were not offered employment until satisfactory checks had been completed. Staff received an induction and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were also supported with supervisions and observed practice.
People could make choices about the food and drink they had, and staff gave support if and when required to enable people to access a balanced diet. People were supported to access a variety of health professionals when required, including opticians and doctors to make sure they received additional healthcare to meet their needs.
The home was meeting the requirements of the Mental Capacity Act (2005). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were offered choices about what they wanted to do. Staff members demonstrated that they understood the importance of enabling people to make their own decisions.
Staff provided care and support with kindness and compassion. There were positive interactions between people and staff. People could make choices about how they wanted to be supported and staff listened to what they had to say. People's independence was promoted and encouraged. There was a welcoming and homely atmosphere at the service.
People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.
Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.
Accommodation and nursing care for up to 20 people is provided in the home over two floors. The service is designed to meet the needs of people with a learning disability and physical disability. There were 19 people using the service at the time of our inspection.
At the previous inspection on 9 and 10 June 2015, we asked the provider to take action to make improvements to the area of safe care and treatment, specifically medicines management and good governance. At this inspection we found that improvements had been made in both of these areas.
A registered manager was in post and she was available during the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Staff knew how to identify and respond to potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices. Safe medicines practices were followed.
Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate.
Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People were treated with dignity and respect. People’s privacy was respected and staff encouraged people to be as independent as possible.
People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.
People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken. The registered manager was aware of their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.
1 Devonshire Avenue provides accommodation and personal and nursing care for up to 20 people with learning disabilities and/or physical disabilities. The home consists of two separate houses on the same site, a larger house for 14 people and a smaller house for six people. 19 people, including two people receiving a respite care service, were living at the home at the time of our inspection. This was an unannounced inspection, carried out on 9 and 10 June 2015.
We last inspected the home on 2 and 3 April 2014. At that time it was not meeting one essential standard. We asked the provider to take action to make improvements in the area of the management of medicines. We received an action plan in which the provider told us about the actions they would take to meet the relevant legal requirements. During this inspection we found that action had been taken to address the issues previously raised. However we found other concerns with how medicines were managed. There was not a sufficient quantity of a type of ‘as and when’ required medicine available in case it was needed. Some items for use when medicines were being administered were not clean. This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Systems were in place for the provider to make safeguarding referrals when needed so that they could be investigated. Staff supported people in a safe way. Risk assessments were completed regarding people’s care. The building and equipment were safe.
There were enough staff present during our inspection to provide safe care. Robust recruitment checks were completed. Staff felt supported and had received an induction, supervision, appraisals and training.
The provider applied the principles of the Mental Capacity Act 2005. The registered manager understood their responsibility in relation to the Deprivation of Liberty Safeguards.
People were supported at mealtimes. Staff knew about people’s eating and drinking needs. People were supported to maintain good health and referrals were made to health care professionals for additional support when needed.
Staff treated people in a kind and caring way. Staff respected people’s dignity and privacy. People were involved in day to day decisions about their care. Staff knew people well and offered them choices and respected their decisions. People were supported to take part in social activities.
A complaints procedure was in place. Staff felt comfortable to speak with the registered manager if they had concerns. The registered manager was very approachable and knew people well who lived at the home.
There was a positive and open culture in the home. Systems were in place to monitor the service. However these had not always been effective. This was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
People were treated with respect and dignity by the staff. Relatives told us they felt their family members were safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Proper policies and procedures were in place. Relevant staff knew when an application should be made, and how to submit one. This meant that people would be safeguarded as required.
However, people were not fully protected against the risks associated with medicines. Medication was not always stored at an appropriate temperature. Information on the medication administration record charts was also sometimes incomplete. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the management of medicines.
Is the service effective?
A person using the service told us they received good care. It was clear from our observations and from speaking with staff that staff had a good understanding of people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.
An external health professional who was visiting the care home during our inspection said, 'Overall I find the care very good here.'
Is the service caring?
People were supported by kind and caring staff. We saw that care staff showed patience and gave encouragement when supporting people. When speaking with staff it was clear that they genuinely cared for the people they supported.
A person using the service told us they received good care. Relatives told us staff were caring and kind. A relative said, 'Staff are always friendly and know how to talk with [family member].'
Is the service responsive?
People's needs were assessed and care plans and risk assessments were regularly reviewed. The service involved other agencies and services. A visiting external health professional told us they were contacted by the care home when their input was appropriate.
Is the service well-led?
The service had a quality assurance system to identify problems and opportunities to change things for the better.
A complaints system was in place. We looked at how complaints had been dealt with and found that investigations had occurred and actions had been taken. People could therefore be assured that complaints were investigated and action was taken as necessary.
Staff told us they felt the service was well run. They told us they could contribute their views on the service. This helped to ensure that people received a good quality service at all times. Staff said if they witnessed poor practice they would report their concerns.
During our visit we saw positive interactions between staff and people using the service. We spent 50 minutes observing the care at lunchtime in the dining room in the larger house and 15 minutes in the smaller house. We saw staff provided support to people who needed this and people were provided with enough to eat and drink. We saw that staff communicated warmly with people as they were supporting them and respected their dignity. We also saw staff asked people about their preferences, recognised how they communicated their views and respected these.
A relative told us they felt there were enough staff and said, 'There are always plenty of staff.'
We found that staff received supervision and appraisals. However, we found some gaps in staff training.
A relative told us they had received a questionnaire to provide their feedback on the service and felt they would be listened to if they raised any concerns. We found there were systems in place to monitor the service and address risks.
We found care records were not always accurate and fit for purpose.
We spoke with two relatives of one person using the service. They told us their relative's privacy and dignity were respected and their relative was well cared for. One relative said, 'The general care is spot on.' They told us they felt their relative was safe.
During our visit we saw that staff were kind, polite and respectful. We spent 40 minutes in the dining rooms in both buildings at lunchtime and observed the care being provided. We saw staff communicated with people in a warm and supportive way and sat down next to some people to provide one to one support.
We found that staff had considered the Mental Capacity Act 2005. We saw that care records supported people's rights to make choices.
Relatives we spoke with told us the building where their relative lived was kept clean and they had no concerns about the building. One relative said, 'Oh it's lovely now. Beautiful.'
We found there were effective recruitment and selection processes in place. We found some gaps in staff supervision and training.
We also found that the provider did not have an effective system to regularly assess and monitor the quality of service that people received and records were not always kept securely.
We spoke to a relative and observed the support staff provided to people who use the service.
A relative visiting the service spoke positively about the staff and said they were 'pleased' with the care provided and that they had 'no complaints'.