Background to this inspection
Updated
6 January 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by three inspectors.
Avocet Trust 22a-26 Middlesex Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with two people who used the service and two relatives about their experience of the care provided. We spoke with nine members of staff including the registered manager, senior care workers, care workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with one professional who has regular contact with the service.
Updated
6 January 2022
About the service
Avocet Trust 22a-26 Middlesex Road is a care home providing personal care for up to six people who have a learning disability and/or autism. At the time of our inspection six people lived at the service. The service is split across four bungalows which are adapted to support people’s care needs.
People’s experience of using this service and what we found
People at Avocet Trust 22a-26 Middlesex Road did not always receive a safe, effective and well led service. We identified concerns relating to people's safety which included poor oversight of fire safety issues, this put people at risk.
The provider had not effectively operated their quality assurance systems to oversee the safety and quality of the service.
Safeguarding concerns had not been reported by staff and management. The registered manager was not clear of their role and responsibility in relation to safeguarding people.
An effective system was not in place to ensure government guidance was adhered to in relation to the management of risks associated with COVID-19.
Medicines were not always managed safely. The provider's policies and protocols were not being followed by staff and management.
Staff training was out of date which meant staff didn’t always have the appropriate skills and knowledge to support people’s individual care needs.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible or in their best interests; policies and systems in the service did not support this practice. We have made a recommendation about this.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The ethos, values, attitudes and behaviours of the management team and support staff did not always ensure people lead confident, inclusive and empowered lives. People were involved in their care and future planning. Care provided was centred around the person however, people’s dignity, privacy and human rights were not always considered. The model of care and support provided to people did not always maximise their choice, control and independence.
People and their relatives told us they were happy with the care and support they received.
Systems were not always in place to recruit staff safely. We have made a recommendation about this.
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 2 October 2019).
Why we inspected
The inspection was prompted in part due to concerns received about safeguarding concerns and the way in which the service investigated these. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only.
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.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avocet Trust 22a-26 Middlesex Road on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to fire safety, management of medicines, staff training and support, failing to operate effective monitoring systems to improve the quality and safety of the service, poor record keeping, notifications of incidents, and safeguarding people from risk of harm.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.