The Avenue Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The provider took appropriate action to review any concerns to see if lessons could be learned. For example, we saw the provider had worked with staff to communicate areas of learning and to improve practice in relation to planning people’s trips. Learning this lesson helps make sure there is a clear record of the support people receive, which protects their financial safety.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Processes were in place to share important information about people. For example, people’s hospital passports were taken with them should they need to go to hospital. A hospital passport ensures healthcare staff understand how best to support the person, including communication methods, likes, dislikes and daily routines.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Staff had safeguarding training and knew how to recognise and respond to signs of abuse. One staff member said, “I would feel confident to raise any concerns. The new manager would act and deal with anything raised.” We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Where people were being deprived of their liberty, referrals had been made to the local authority. The manager monitored people’s Deprivation of Liberty Safeguards (DoLS) referrals, and any conditions attached to a person’s authorised DoLS. Where people had capacity appropriate recording and documenting was in place such as expenses and receipts records, however, this could be strengthened further, by ensuring external professionals views were consistently recorded.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People had care plans and risk assessments in place. People’s needs had been identified, and appropriate support was in place. One person told us, “A district nurse visits daily to administer insulin. Staff at the home help me to manage my diet.” Staff were able to demonstrate they understood the risks to people and how to reduce them. For example, a person and staff worked together to implement a new form of technology in the form of a tracker which is used on the person’s phone to enable them to go out independently. The tracker sends live updates of their location to the management team. It can also send urgent notifications to emergency services if the person needed it.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider was currently undertaking renovation works within the home. This included the renovation of a double room, which 2 people were sharing, into 2 single rooms, to give them their own room and space enhancing privacy and dignity. Decoration of bedrooms, corridors, communal areas and new flooring were also planned. Appropriate checks were carried out on the environment, for example checking water temperatures to avoid risks posed such as scalding. Window restrictors were in place to prevent accidental or intentional falls. However, we identified not all window restrictors were tamper proof. This meant there was a risk the safety mechanism could be easily removed or disengaged by people. The providers acted immediately and ordered tamper proof screws which we saw evidence of. Fire safety processes and checks were carried out regularly, records showed regular testing and auditing of equipment and systems within the premises. An external company had recently carried out the annual fire risk assessment, actions identified from this had been addressed and implemented. For example, fire safety instructions were now visible to all visitors when entering the home. Staff had received training in fire safety and people had personal emergency evacuation plans (PEEPs) in place which detailed what support was required. Fire drills were carried out to ensure the safety of people in the event of a fire. A relative said, "The environment is safe and friendly.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. People told us there were sufficient staff to meet their needs. One person told us, "There are always enough staff. I have an emergency button, and they (staff) always respond immediately if I press it.” However, a relative said, "They sometimes seem a bit short of staff.” Staff also told us they would benefit from another staff member being on shift in the mornings when it is the busiest time. A dependency tool was in place to plan staffing levels. Agency staff were used rarely, and when they were, it was the same consistent agency staff. This meant people were supported by a consistent staff team who knew them well. We observed there were sufficient staff during our visits. Staff were responsive when people needed assistance and were knowledgeable about people’s individual needs. Staff received the relevant training to enable them to carry out their roles effectively and safely. This included training in areas such as learning disability and autism, mental health, bipolar disorder, communication, dementia, diabetes, down syndrome, epilepsy and first aid. Staff rotas showed a regular staff team which meant there was continuity of care for people. One relative said, "Staff have stayed the same which is important to my relative. They (staff) understand their needs.” Staff were recruited safely. This included requesting and receiving references from previous employers, right to work documentation and Disclosure and Barring Service (DBS) checks. The DBS checks help employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.Staff received training in infection prevention and control (IPC). Domestic staff were responsible for cleaning the home. We observed the home to be clean and tidy. However, the domestic staff hours were not spread out throughout the day and did not cover weekends. This meant deep cleans were potentially not happening. The management team were currently in conversations with the human resources team to address the potential shortfalls from not completing regular deep cleaning due to staff hours and housekeeping coverage. Comments from relatives included, "The home never smells,” and “The home is clean and tidy.” The provider had appropriate policies in place and regular IPC checks of the environment and equipment were carried out. The management team understood their responsibilities to report infection outbreaks to the relevant health authorities. The home had a food hygiene inspection and was rated 5 stars. This meant food hygiene standards were very good and fully comply with the law.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Medicines were managed safely. As and when (PRN) medicines had clear protocols in place so staff knew when they should be given and what signs to look for. For example, signs a person may display if they were in pain was clearly documented on protocols. Where people were prescribed transdermal patches there was clear guidance on patch rotation and use in place. There was a medicines policy in place and staff had received training and competency checks prior to administering medicines. Audits were completed monthly by the manager with any actions identified and completed. In addition, people’s medication care plan and all prescribed medicines were reviewed during resident of the day checks.