Archived: Carter Avenue

Best practice guidelines recommend supporting people living with a learning disability in settings that accommodate less than six people. The service model at Carter Avenue was therefore aligned to the principles set out in Registering the Right Support. The service goals for people using the service reflected the principles and values of Registering the Right Support including; choice, promotion of independence and inclusion. Overall people's support was focused on them having as many opportunities as possible, to have new experiences and to maintain their skills and independence.

People’s experience of using this service:

A person told us they enjoyed living at Carter Avenue. They said they felt safe and staff were nice. People's relatives were also positive about the service. People were supported to participate in a range of activities of their choice.

Although we found areas of improvements since the last inspection, we also found some areas of practice that had the potential to place people at risk. Where marks or bruising had occurred, these were not promptly investigated by the registered manager meaning that action to mitigate any risks or causes of injuries may be delayed. People received their medicines safely and as prescribed, although audits had not identified that these may not always be stored at safe temperatures. Governance systems used to assess the quality and safety of the service did not always identify concerns and drive improvement.

People received support which met their needs, staff knew what was important to people. People's dignity and privacy were respected.

People's rights to make their own decisions were respected. Staff supported people to make choices in line with legislation. However, people could not access the rear garden independently due to steps and uneven surfaces. This provided an unnecessary restriction for people.

The environment was generally clean, and plans were in place for a major redecoration and refurbishment of the kitchen and other areas of the home.

People and family members knew how to complain and were confident that if they raised concerns, the registered manager would act promptly to address these.

At this inspection the service met the overall characteristics of requires improvement; more information is in the full report.

Rating at last inspection: The service was last inspected in February 2018 where we undertook a full comprehensive inspection (report published May 2018). It was awarded a rating of Requires Improvement.

Why we inspected: This was a planned inspection based on the previous inspection rating.

Follow up: We found two breaches of regulations. The service remained rated as requires improvement. We will request an action plan from the registered provider about how they plan to improve the rating to good and meet the requirements of the regulations. In addition, we will meet with the provider to discuss their plans to make improvements. We will also continue to monitor all information received about the service, to review any risks that may arise and to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Carter Avenue is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Carter Avenue is a local authority run care home which provides accommodation for up to six people with learning disabilities and Autism who need support with their personal care. At the time of our inspection there were three people living in the home.

The home was arranged over two floors with most of the bedroom accommodation on the first floor. There were bathrooms available to people on each floor. There were three communal areas in the home, which were a kitchen, a dining room and a lounge.

The home had a registered manager. 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. The registered manager was not present during the inspection but a senior staff member was available.

The last comprehensive inspection of this service was in September 2015 when the service was rated Good. At this comprehensive inspection we found the service was not meeting legal requirements and required improvement.

There was a complaints procedure in place to enable people to raise complaints about the service.

However, low level complaints were not being captured and information was not presented to people in a way they could understand.

Quality assurance systems were not always robust to monitor and review the quality of the service which was provided. These had not been used effectively to identify concerns we found or drive improvement in the service.

Records of the assessment of people's ability to make some informed decisions had been undertaken. However, the principles of the Mental Capacity Act 2005 were not being applied in respect of best interest decisions to provide care. Staff we spoke with had a variable understanding of the Mental Capacity Act 2005.

People and their relatives were not regularly involved in the assessment and the on-going reviews of their care. Care plans were not written in a way that would enable people to understand and be involved in decision-making.

Staff received training; however, some training to meet specific needs had not been provided.

People received their medicines as prescribed. However, we identified some areas where improvements could be made to ensure the safe administration of medicines and of topical creams.

Families told us they felt their relatives were safe at the home. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Staff knew how to identify, prevent and report abuse.

Plans were in place to deal with foreseeable emergencies such as fire risk; staff we spoke with said they had had received training to manage such situations safely.

People were supported to maintain their health and well-being. Staff supported people to attend

appointments with healthcare professionals. People were encouraged to eat healthily and staff made sure people had enough to eat and drink.

People did not have many opportunities to take part in activities within the local community.

Risk assessments that related to people's health and safety were effectively assessed. Action had been taken to reduce identified risks to help ensure the safety of people.

Staff received regular and meaningful supervision and staff had an opportunity to voice their individual views.

We received some positive feedback about the care staff and their approach with people using the service.

Relatives and external health professionals we spoke with were positive about the service people received and people's visitors were welcomed.

People’s relatives felt confident to approach the staff or registered manager and felt they would be listened to.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 . You can see what action we have taken at the back of the full version of the report.

Our inspection was undertaken by an adult social care inspector. We observed care and support being given in communal areas of the home and viewed records relating to care. We spoke with one of the four people living at the home, two members of staff and the manager. This inspection was following up on concerns identified during an inspection of the home on the 30 April 2014.

This is a summary of what we found:

We viewed the communal areas of the home, the kitchen, the bathroom and looked in people's bedrooms. We saw that everywhere was clean and appropriately maintained. The person we spoke with told us they did not have any concerns regarding infection control or cleanliness within the home.

The manager told us they were the infection control lead for the home, which had appropriate risk assessments. There was also an effective audit process in place to ensure standards were maintained.

Staff had received infection control training and were able to demonstrate their understanding in a practical way.

In this report the name of a registered manager appeared who was not in post and not managing the regulatory activities at this location at the time of the inspection. This was because they were still a registered manager on our register at the time of this inspection.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

The manager had identified the risks and hazards associated with providing care within the home. These included risks associated with the kitchen, the bath hoist and the concrete steps. We also saw risk assessments associated with specific elements of people's care, such as falling, exposure to sunlight, taking their seat belt off while travelling in the car/minibus and specified the action required to manage those risks.

During our previous inspection on 3 September 2013 we found the home was not clean and people were not protected against the risks of infection. We set compliance actions and the provider wrote to us, telling us how they would become compliant. During this inspection we saw that people were cared for in a clean and hygienic environment. However people were not safe because they were cared for by staff who had received appropriate training but didn't always put this into practice. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control practices.

The manager ensured there were enough staff working at the home to meet people's care needs. We saw that staff had received appropriate training and support to ensure they had the skills and experience necessary to meet people's needs.

Is the service effective?

We saw that although most of the people who used the service were not able to verbally communicate with staff, they were able to communicate their understanding of what they were being asked and make their wishes known, through noises and body language. People and the relatives we spoke with told us they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking to staff that they had a good understanding of the people's care and support needs and they knew them well. A relative said they had spoken to their relative's keyworker and discussed their care needs. They added 'I always come away very impressed'. Care records showed people had access to appropriate medical care, including GPs, dentists and chiropodists. Therefore people's needs were known and met.

Is the service caring?

People were supported by kind and attentive staff. The person we spoke with and relatives told us that staff treated them with respect and dignity. One person said 'staff always knock on my door and ask me if it is alright to come in'. The care plans we looked at were personalised to reflect the individual needs and people's likes and dislikes.

The person we spoke with told us they 'liked' the home and 'liked the staff, they are nice'. A relative said their relative was 'very happy there'; and added, 'Care is always very good. I am quite happy with the level of care they provide'.

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with their wishes.

Is the service responsive?

We observed care in the communal areas of the home and saw staff interacting with people in a positive way. For example, we saw one person's care plan had been recently updated 'staff need to give more assistance when moving around'. We observed the care throughout the day of our inspection and saw staff supporting this person in a positive way with their mobility.

People had the option to engage in a range of activities and were involved in a number of outside activities such as trips out to another home for a musical evening, a picnic at the beach, shopping and a visit to McDonalds. People also took part in activities at the home such as playing catch with a balloon or playing with musical toys and played in the garden.

There was an effective compliments and complaints policy in place and we saw there was also an easy read version available to people. The manager showed us their complaints file and told us they had not received any formal complaints during the last year. The family members we spoke with told us they knew how to complain but had no reason to do so.

Is the service well-led?

We saw there was a structured quality assurance process in place to regularly assess and monitor the quality of the service people received. These included support plan audits; cleaning l audits; medication administration record (MAR) audits and fire safety equipment audits. We found some of these audits were also carried out by external professionals. Where issues were identified we saw these were responded to promptly.

There was a new staff meeting structure, where staff could raise any issues or concerns.

We saw that although people were not able to verbally communicate with staff, they were able to demonstrate their understanding of what they were being asked and make their wishes known. We saw staff seeking consent from people before providing care and support. We spoke with the family of one of the three people who used the service and the friend of another. They told us they did not have any concerns regarding the obtaining of consent from their relative or friend.

We also spoke with three members of staff and the manager who said they understood that people were able to make decisions for themselves and described the action they would take if people refused care. We observed care in the communal areas of the home and saw staff interacting with people in a positive way. People were relaxed when with staff, who responded to people's needs in a balanced and supportive manner. One relative said, staff 'provide excellent care' and added 'living here has been very good for [their relative]'.

We found that although there were systems in place to reduce the risk and spread of infection, these were not adhered to. We found parts of the home were not clean, and the mattress on one bed was badly stained with urine.

We found there was a duty roster system, which detailed planned cover and the arrangements in place to manage short term absence. We saw the home had a safeguarding policy and staff had received safeguarding training. The provider had a quality assurance system in place and sought the views of the families of people who use the service through an annual survey.