• Care Home
  • Care home

Archived: The Avenue Residential Home

Overall: Requires improvement read more about inspection ratings

3 The Avenue, Acocks Green, Birmingham, West Midlands, B27 6NG (0121) 693 0182

Provided and run by:
Kelso Care Consortium Limited

All Inspections

26 and 27 August 2015

During a routine inspection

We inspected this home on 26 and 27 August 2015. This was an unannounced Inspection. The home was registered to provide care and accommodation for up to ten people who may have a learning disability or mental health support needs. At the time of our inspection eight people were living at the home. The accommodation was provided in single bedrooms; the home had bedrooms and bathrooms on the ground and first floor. There were shared lounge, kitchen and dining facilities available on the ground floor.

The service was previously inspected in July 2014 and at that time we found the service was not compliant with three of the regulations we looked at. The issues identified were that the provider did not have suitable arrangements in place for managing care and support needs of some people who used the service which impacted on others who used the service, safeguarding arrangements to protect people who used the service from abuse needed to be improved and arrangements for assessing and monitoring the quality of service provision were not wholly effective. The provider took action and at this inspection we found improvements had been made.

The registered manager was present during 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.

There was a CCTV system in use in areas of the home used by people who used the service. This was an established system but use of this had not been updated in light of new guidance and agreements about use of the system had not been reviewed. You can what action we have asked the provider to take at the back of the full report.

We found that not all people using this service felt safe. Although staff knew how to recognise when people might be at risk of harm and most were aware of the provider’s procedures for reporting any concerns, staff did not follow safeguarding procedures that they had been instructed in on the day of the inspection. The registered manager took prompt action when they were informed of the safeguarding concern.

The service provided enough staff on duty with the right mix of skills and abilities to make sure that people’s needs were met and that they could respond to emergencies. Robust recruitment checks were in place to ensure staff were suitable to work in the home. We found that there were sufficient numbers of staff available to meet people’s individual needs.

People had received their medicines safely. We observed staff practising good medicine administration.

People’s needs had been assessed and care plans developed to inform staff how to support people in the way they preferred. Measures had been put into place to ensure, in most instances, that risks were managed appropriately. These ensured that people were involved in making decisions which minimised restrictions on their freedom, choice and independence.

People were supported to eat and drink sufficient amounts to maintain good health. People were supported to stay healthy and were supported to have access to a wide range of health care professionals.

Most staff we spoke with were aware of their responsibilities under the Mental Capacity Act 2005 (MCA) and the Deprivations of Liberty Safeguards (DoLS) to protect people’s rights. Some necessary applications to apply for restrictions from the local supervisory body had not been progressed or submitted in a timely manner, failing to protect the rights of people.

Staff treated people with respect and communicated well with people who did not use verbal communication. People told us they continued to pursue individual interests and hobbies that they enjoyed and they were happy with the range of activities available to them.

There was a complaints procedure in place. People told us they had opportunity to raise concerns and that they were listened to. Relatives told us they knew how to raise any complaints and were confident that they would be addressed.

We found that whilst there were systems in place to monitor and improve the quality of the service provided, these were not always effective in assessing the quality of the service provided.

25 July 2014

During an inspection looking at part of the service

The inspection team was made up of one inspector. There were nine people using the service during our inspection. The majority of the people living in the home were able to speak with us but three were unable to answer questions fully. We spoke with six people and observed the care staff provided. We also spoke with three staff, the manager and the area manager for the service.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

At our previous visit in November 2013 we found that there was insufficient management of and recording of situations where people and staff were at risk of being harmed. Before this inspection we received information that these situations were still not being managed well.

We spoke with people who lived in the home and they told us that they did not always feel safe there. They told us that staff tried to keep them safe but that they felt unsafe when staff were hurt when people presented behaviour that was challenging to manage. We saw that staff tried to re-direct people and intervene if people were becoming upset. A person told us: "When I am upset and angry staff try to talk to me and try and solve my problems." However risks to people remained and some activities were curtailed because of these situations. Since the inspection and the finalising of this report the population of the home had changed and risks of people being harmed had been minimised.

The provider had not notified the local authority or us, as required by law, of some incidents that had occurred that should have been reported under safeguarding procedures. This placed people at risk as incidents where people were hurt and were not independently reviewed.

People were protected by proper and appropriate use of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS). There were people in the home who had restrictions placed on them. These safeguards apply where it is thought that it is in someone's best interests for restrictions that limit a person freedom of movement. In these circumstances the provider must apply for authorisation to deprive the person of their liberty. These had been applied for appropriately. The provider was also considering the implications of a numbered lock on the front door of the home.

We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

At our last inspection in November 2013 we found that there was a lack of variety in menus and choices that did not promote healthy eating habits for people. At this inspection we had found that improvements had been made in the variety of food available. People were encouraged to be involved in the preparation of food and eat healthily. Some people chose to be involved and some people did not. Comments included: "I like (a named member of staff) they are teaching me how to cook. I made spaghetti Bolognese," "I like making pizzas" and "I don't cook." We looked at records of people's weights and found that the majority of people had made progress towards their goal of attaining a healthier weight. The measures taken by the home had been effective.

At the inspection in November 2013 we found some people's leisure activities were restricted. At this inspection people we spoke with were happy with the activities they had participated in. Staff we spoke with told us that the range of activities people had enjoyed had improved.

Is the service caring?

We saw that when staff interacted with people they were kind and caring and intervened only when they needed to. People were supported with their personal care needs where needed. People's hair and nail care had been attended to and people had been supported to wear appropriate clothing for the weather. We spoke with people about the care they received and amongst their comments were: "I like it here, I think I am getting better at cooking," "Staff and the manager are kind to me but I don't want to stay here," "The staff like me" and "The staff are okay; they care for me." People living in the home felt cared for.

Is the service responsive?

There were a number of areas at our last inspection where we found improvements needed to made to ensure that people received the care they needed and were listened to. At this inspection we found that action had been taken in a number of these areas. Measures in place to improve the range of activities and health of people had been introduced and were being enjoyed by people using the service. People had been supported to become more involved in certain aspects of their daily lives in line with their wishes and interests.

Is the service well led?

The home had a new manager and appropriate arrangements had been made by the provider to ensure that they were registered with the commission.

Monitoring measures used in the home were not always up to date and this meant that information that could be used in determining triggers and pressure times for incidents may be lost. Some information where concerns had been raised did not a clear process to ensure that the home could track what action they had taken and the outcome.

We looked at the incident records and found that they contained details of what had happened. Each incident was reviewed to see how the management of the situation could have been improved. There had been referrals to appropriate health professionals for support and guidance. Staff had received training but there were mixed comments from staff about how competent they felt about managing situations where people were upset. Reviews of incidents were scheduled monthly but this had not been completed for June 2014. Further improvement was needed to ensure that people felt safe in the home.

People told us that they felt able to raise their concerns with both staff and the management of the home.

We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to the assessing and monitoring of risk.

20 November 2013

During a routine inspection

During our visit we met all ten of the men currently living at The Avenue and the staff on duty. All the feedback we received from people living at The Avenue was positive and included: "OK, I like it here, stay here for good " and "I like everything here. I like my bedroom, I can cook pizza, I can go out with staff and buy sweets." We asked one person if there was anything they disliked and they answered: "No." Staff feedback included: "I really like the people I support, the training and the people around me."

We saw that people were supported to complete personal hygiene to a high standard. People had individual care plans but these had not been developed for all health needs.

People told us they felt safe at The Avenue and we saw systems in place to ensure this was the case. One person said: "This home's not nasty,it is good."

We found medicines were well managed and we were confident people were getting the right medicines at the right time.

Staff told us they were well trained and felt supported. One staff member said: "I have just completed autism training. It has helped me understand the men here better."

We were told that the home was well managed. Comments included:"I feel the home is well managed and organised. There is a clear chain of command." We found that checks and audits were undertaken but these had not been entirely effective.

13 November 2012

During an inspection looking at part of the service

At our last inspection on 18 July 2012 we found that: - risks to people, medicine administration, improvements to the environment, training of staff and involvement of people in their care were not sufficiently managed and monitored. This put people at risk of harm. We issued a warning notice for the home to improve.

On this visit we found that substantial improvements had been made. Care Plans and risk assessments had been reviewed, renewed and reorganised. We spoke with four care staff. They were knowledgeable about the risks to people that lived in the home and plans to minimise risks for individual people.

Medicines were administered safely and appropriately, and could be accounted for. Management and care staff who administered medication had been retrained.

People who lived in the home had the opportunity to be involved in the decisions about the home's refurbishment and decoration which was now almost complete.

Enough care staff had received training to be appointed first aiders and fire marshals for the home to be continuously covered making people more safe in an emergency. There had been substantial improvements in the systems to monitor all aspects of health and safety. The provider had taken steps to ensure continued improvements in staff records.

18 July 2012

During an inspection looking at part of the service

The Avenue Residential Home is registered to provide accommodation for people who require nursing or personal care and can accommodate 10 people. People living in the home have a learning disability. Some people have autism and / or have behaviour that can be challenging. The home does not provide nursing care.

16 November 2011

During a routine inspection

During our visit on 16 November 2011 we spoke to four people. Three people told us they were happy living at The Avenue. One said that they wanted to move back to a home that was no longer open. A person spoke about moving on to a more independent environment but said that they were happy at The Avenue.

All the people spoken to thought the manager of The Avenue was very good. They said: "She sorted things out." One person who was expecting to have a health procedure said: "The manager is going to be with me every step of the way."

Most people enjoyed the activities that they undertake. One person had been applying for jobs and had been unsuccessful and found this difficult. People were encouraged to save for holidays. One person told us how much they had saved.

We spoke to one health professional who told us that the person they were responsible for had settled very well. They told us that care workers had got to know them very quickly.