Avondale House

Avondale House is a ‘care home’ for eight people of varying ages who required mental health support. The premises was located close to shops and the local sea front. At the time of inspection there were eight people living at the service.

People’s experience of using this service:

The atmosphere at Avondale House was warm and friendly. Staff were supportive and encouraged people to live full and active lives and to achieve their goals. One person told us how it felt to live at Avondale House; "It felt unreal, the amount of support since I have been here. I'm a different person." Another commented; "I love living here, it’s a really good place, good staff, they are very good, they do their jobs to the absolute maximum."

People had good relationships with staff, who were knowledgeable of their physical and emotional needs, as well as likes, dislikes and interests. Staff were receptive to changes in people's mood and health and sought immediate advice from colleagues and relevant professionals. Contemporaneous and accurate notes were kept and recorded electronically which allowed staff to quickly identify patterns, trends and triggers and put in the necessary measures to maintain people's health and reduce risk.

People felt safe living at the service. The registered manager carried out the appropriate checks to ensure staff were safe to work with people. Staff had the knowledge and skills to protect people from harm and abuse. People were supported by an appropriate number of staff, with the knowledge and skills to support them. People chose how they wanted to be supported and by whom and this was regularly reviewed. Staff understood the principles of the Mental Capacity Act 2014 and were respectful of people and their choices. Peoples information was kept securely, and staff understood the concept of confidentiality.

People were encouraged to be as independent as possible, some were supported to build the knowledge and confidence to travel unaccompanied in the community, whilst others were encouraged to do as much as possible for themselves when having personal care. People were supported to learn and maintain life skills, such as; cooking. Staff promoted healthy eating and exercise, and had begun healthy eating projects, cooking classes and exercise sessions at the premises and within the community.

People told us that they enjoyed the company of staff and were supported to try new experiences and activities. If people had ideas and suggestions for new activities, these were raised at house meetings and actioned by staff. If people had concerns or complaints, they felt comfortable raising these with staff and the registered manager. People were fully involved in their care planning and received information in a way that they understood.

The premises were clean, well-maintained and people's bedrooms were decorated according to each person's style and preference. People were protected from the spread of infection and medicines were stored and managed safely.

The registered manager and staff conducted regular checks to monitor and maintain the quality of support provided to people. They reviewed trends and patterns and took appropriate action as a result. Staff felt supported by the registered manager who encouraged them to reflect upon their own practice, and that of the service and to think 'outside the box' and share any ideas and/or concerns. Staff used innovative ways to help people to achieve their goals and to promote positive outcomes.

Rating at last inspection:

Comprehensive inspection published 20 July 2016 – Good with a breach around staff recruitment in the safe key question. Found to be compliant following focused inspection published 4 March 2017.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive. We will follow up on identified areas for improvement at the next scheduled inspection.

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

At the last inspection, the service was rated Good overall and Requires Improvement in the Safe domain.

We carried out an unannounced comprehensive inspection of this service on 28 June and 01 July 2016. A breach of legal requirements was found. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 19(1)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Fit and Proper Persons. We undertook a focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from out last comprehensive inspection by selecting the ‘all reports’ link for Avondale House on our website at cqc.org.uk.

At this inspection we found the service remained Good and is now rated Good in the Safe domain.

The service had improved since the last inspection. Recruitment checks were being consistently completed to make sure staff were honest, trustworthy and reliable to work with people.

People told us they felt safe living at Avondale House and said they would speak with staff if they had any worries or concerns. They were confident that their concerns would be listened to and that action would be taken. There were enough staff on each shift to keep people safe.

Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time. Regular health and safety checks were carried out on the environment.

Staff knew about abuse and knew what to do if they suspected any incidents of abuse. Staff were aware of the whistle blowing policy and how to take concerns to agencies outside of the service. Staff were confident that any concerns they raised with the management team would be investigated to ensure people were kept safe.

Avondale House provides accommodation and support for up to seven people with mental health needs. The service is located in a residential area in Westgate-on Sea and is walking distance to local shops and the beach. There are good public transport links with bus stops and a train station nearby. At the time of the inspection there were six people living at the service.

The provider had a recruitment and selection policy however this had not been followed to make sure staff were of good character and safe to work with people.

The service is run by a registered manager who was present on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

People told us they felt safe living at Avondale House. Staff understood how to protect people from the risk of abuse and the action they needed to take to keep people safe. Staff were confident to whistle blow to the registered manager and were confident that the appropriate action would be taken. Staff said they would not hesitate to contact other organisations outside the service if they needed to.

Risks to people’s safety were identified, assessed and managed. Assessments identified people’s specific needs, and showed how risks could be minimised. Accidents and incidents were recorded, analysed and discussed with staff to reduce the risks of them happening again.

There was a comprehensive training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided regularly. People told us they were consistently supported by sufficient numbers of staff who knew them very well.

People received their medicines safely and told us they received their medicines when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. There were no people living at the service under an authorised DoLS.

People felt informed about, and involved in, their healthcare and were empowered to have as much choice and control as possible. People were able to make choices about how they lived their lives, including how they spent their time. Staff had received training on the MCA and understood the key requirements of the MCA and how it impacted on the people they supported especially relating to healthcare treatment. They put these into practice effectively, and ensured that people’s human and legal rights were protected.

People were supported to maintain good mental and physical health and had access to health care professionals when needed. Staff had strong working relationships with health professionals, such as, GPs, psychiatrists and the local mental health team.

The registered manager and staff carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. Emergency plans were in place so if an emergency happened, like a fire or a flood, the staff and people knew what to do.

People were supported to maintain a healthy and balanced diet. People were involved in cooking and were supported to buy shopping for the service. Staff monitored people’s weight to make sure they were staying healthy.

People were said they were happy with the care and support they received. Care and support plans contained information and guidance so staff knew how to provide people’s support in the way they preferred. Staff were familiar with people’s life stories and were knowledgeable about people’s likes, dislikes and preferences.

People were involved with the planning of their care from before they started to live at Avondale House. Care and support was planned and given in line with people’s individual mental healthcare needs. People spoke positively about staff and told us they were supportive, kind and caring. Privacy was respected and people were able to make choices about their day to day lives. Staff were respectful and compassionate when they were supporting people.

People, staff and health professionals were encouraged to provide feedback to the registered manager about the quality of the service. People said their views were taken seriously and any issues they raised were dealt with quickly. People told us they did not have any complaints about the service or the support they received from the staff.

People planned their own activities each week and spent time in the local community. People enjoyed group trips to local places of interest and activities in the service, such as gardening and cooking.

People and staff told us the service was well-led. Staff said they felt supported, that the registered manager was approachable and that they worked closely as a team. There was a positive, person centred and open culture at the service. Staff had developed strong links with the local community.

The registered manager coached and mentored staff through regular one to one supervision. Staff were clear about what was expected of them and their roles and responsibilities and told us they felt supported by the registered manager.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.

The people using the service and the staff spoken with all said they were very happy with the changes and felt it all worked out well. The home had also increased its number of beds from four to seven. Bedrooms seen were all of large proportion giving the people plenty of their own space as well as communal areas. The kitchen had some lockable cupboards and the staff explained this was because some of the people bought and cooked their own food and this enabled them to keep it safe.

Notice boards in the kitchen and corridors showed the people timetable of events they could join in should they want to. These included films nights, trips out, and meetings to discuss future activities and address any issues that had arose since the last meeting. These meetings were often held off the premises at a local cafe to incorporate breakfast. Interactions between the staff and the people were observed to be respectful and friendly. People spoken with were very positive about the home, and all confirmed they felt safe and supported. One told us that the cleaner came in daily to look after their room.

People told us they were happy with the care they received and they felt that they were listened to and well supported.

Staff were observed interacting with people in a relaxed and friendly way. They talked with people and gave reassurance and support when needed. People's wishes for independence were encouraged and staff and management showed a good understanding of people's needs.

We saw that people were treated with dignity and respect and had choice. We found that people's views and needs had been recorded and acted upon.

We found that there were enough staff on duty to meet people's needs and that staff were well trained and supported. Safeguarding issues were understood and addressed.