Avondale House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.At our last assessment we rated this key question Good. At this assessment the rating has changed to Outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. The service worked in partnership with people to review their care to ensure it reflected people’s needs, preferences and hopes for the future. People felt empowered and in control of their care. One person told us “Staff are really good and keep me organised and help me plan the things I want to do”. Staff reflected that people were the experts in their own care, and were proactive in asking people how they wanted to receive care and about the things that were important to them. There was an ethos of ensuring people were always in control of their own care and support. A staff member explained “People know their own mental health better than anybody, so they will let you know what is working for them as important to listen to them”. Staff advocated strongly for people and always reiterated that they were the best people to inform their own care. There were regular opportunities for people to give feedback on their own care, and to work alongside staff to plan activities or events that reflected their own unique wishes and preferences. The service had introduced “achievement rings” which were ring binders displays throughout the service and staff completed to recognise people’s achievements, to showcase people’s personal development and growth.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. There had been a period where there had been greater turnover of staff, but feedback from both people and staff was that this had now improved and there was a consistent staff team or worked together closely and knew people well. People felt understood and seen by the staff who worked with them, and told us they felt they worked closely with them to help them achieve the things important to them. For example one person told us “(Staff member) is great at helping me with my boundaries. I am a better person than I was. Staff help me understand things and don’t judge me”.

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs. We saw a number of creative ways staff were working closely with people to ensure they received information in a way that was accessible to them, and empowered them to be involved and in control of their own care and daily life. The service had created email addresses for each person to allow them to manage their own correspondence and access their care documentation. This gave people control over their own communication on their own terms. There was clear information recorded about each person’s communication needs and emphasis placed on communicating with people in a way that reflected them with respect and as adults, which we saw in practice during our inspection. One person had been supported to create their own communication tools, and staff would help them plan ahead of medical appointments by sitting with them and writing down points they wished to raise in advance. This ensured they were able to fully participate in their own health and care by sharing the information they wanted to raise during appointments, and have their voice and lived experience of their health heard.

Where people need representatives to advocate for them during complex or distressing events, the service would proactively work with local advocacy services to make sure people were given a voice during these conversations. The service had also developed their own mini guides to a range of a topics including mental health, managing relationships, accessing the community, education and careers which allowed people to access important information in an easy and accessible way. This meant people had clear accessible available to support them in making informed daily decisions and life choices.

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result. People and relatives told us they felt comfortable in sharing any feedback, and were actively involved in their own care. As well as regular surveys, the service had introduced a “Strengths and Strains” system where people could submit feedback using an online portal at any time. This would be analysed and responded to by managed. There were regular house forums where people could meet as a community to raise suggestions and plan things they wanted to do together. This reinforced strong social bonds with their peers, and gave them control over where they lived. There were also regular individual meetings allowing people an opportunity to reflect on their own care. One person told us “Yes, we are asked for our ideas, like we said we needed a bigger kitchen. The maintenance person made a bigger kitchen for us and now lots of us can cook together”. This allowed people to develop important life skills and socialise together whilst preparing meals. During our visit we saw a group of people sitting together in the kitchen, assisting one person in contacting their bank and manage their finances. Relatives told us they felt they would always be able to raise any concerns and that they would be listened to and respond to appropriately. One relative explained “I’ve never complained with Avondale. I think the manager would take it seriously, I’ve not had any cause to complain. He would definitely listen”.

The provider was exceptional at ensuring people could access the care, support and treatment they needed when they needed it. There were clear plans in place for how each person could access the care and support they needed, and how staff would work with them to support removing barriers to care in and their daily lives. People explained how staff would attend health appointments or support groups with them if they felt they needed additional support, and home visits were arranged to ensure everybody had an opportunity to access. For example the provider had recently arranged visits from a chiropodist who told us “One person required additional communication support, and staff appropriately provided this assistance. I viewed this as an excellent demonstration of patient-centred care and an understanding and respect for consent”. Staff ensured that people had all necessary support to be engaged and supported in managing their own health, and in combatting health inequalities that are more common in people with a mental health diagnosis or who have a learning disability or are autistic.

People spoke passionately about the difference the service had made to them or their loved ones, including in being able to actively engage with their own care and the wider community such as personal relationships. Staff understood and empowered people to ensure they had equity in experiencing the same things as other people. This included understanding the importance of relationships and sexual relationships people wanted to pursue. Where this had been a risk for people, staff had dedicated time and expert knowledge to ensure people were informed and comfortable to enable them to pursue: this was previously this was not an option for them.

One relative told us “When my relative first moved to the service they wouldn’t go out the door and was scared of going out. The service have worked wonders”. Another relative told us “I truly believe the care and encouragement they have received from the team has given me my relative back. I do not know what I would have done without them”. These were among many examples of life changing and impact of staff on people that were shared with us during our inspection.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this. The service worked closely with people to help them overcome barriers to participating in daily life, and in having the quality of life that others in society take for granted. The provider had developed their own suite of resources which guided staff through having complex discussions around people’s mental health. This included how this impacted people specifically around everything from planning a train journey to preparing meals, taking part in activities and overcoming other challenges in day to day life. These were used to design monthly focused meetings with people, and explore how these barriers could be removed to allow people to achieve their ambitions and life independently. One person was being supported to access education and to use this learning to develop crucial life skills that they could take with them at a point where they might be ready to live independently. Staff were working closely with this person to review this focus, and look creatively at how they could empower them to take ownership of their own education. This included arranging a visit from the college, and ongoing accessing to online education sessions.

The service had also recently introduced a key worker role with protected time to lead these conversations. A staff member explained “Recently we have focused on working with one person with an alcohol addiction who is now sober, which is a massive achievement. We have been meeting regularly with them to talk about how this is going. I think the key worker role is really positive as it allows us focused time to think creatively about people’s mental health needs”.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. There were clear plans for people on what their wishes for the future were, for example people had expressed a wish to get a job, enter education, move into their own accommodation or develop safe relationships. There were detailed plans set out on how people could achieve these, and the steps that would be involved including how staff would work with people to support them in overcoming any barriers or challenges to achieving their goals.

The service had discussed people’s preferences around the end of life with them, and we saw examples of them working closely with people to explore bereavement following the loss of a family member. Not all people had end of life plans in place which the provider explained was because they did not wish to talk about it at present, but they had already identified the need for further work to explore these with people to ensure this conversation remained open to give people an opportunity to talk about end of life in a safe and open way.