Avocet Trust - 523-525 Marfleet Lane

Avocet Trust - 523 – 525 Marfleet Lane is a care home providing personal care for up to seven people with a learning disability, autism and/or physical health needs. There are two separate bungalows, each of which have adapted facilities. At the time of our inspection, six people were using the service.

We found the following examples of good practice.

¿ Visitors were asked questions about their health and their temperatures taken to ascertain any risks. Their details were kept for track and trace purposes. All visitors were supervised to ensure they followed infection control guidelines and wore appropriate personal protective equipment (PPE).

¿ People who used the service and staff followed social distancing practices.

¿ People who used the service were supported to maintain contact with their families and friends through phone calls, video calls, emails and window visits.

¿ Staff appropriately wore PPE in line with current guidance. PPE was accessible for staff around the service and staff were trained in putting on and removing PPE.

¿ Regular testing of people who used the service and staff was completed in line with current guidance. Clear procedures were in place to make sure people and staff self-isolated when necessary.

¿ The service was clean and tidy. Robust cleaning schedules and appropriate cleaning products were in place and available for staff to use. Staff regularly cleaned high-touch areas to minimise the risk of people catching or spreading COVID-19.

¿ Staff were dedicated to their roles and committed to living in the service when needed to ensure people’s needs were met.

Further information is in the detailed findings below.

523 – 525 Marfleet Lane is a care home providing personal care for up seven people with a learning disability, autism and/or physical health needs across two separate units, each of which have separate adapted facilities. At the time of our inspection six people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

Everyone we spoke with was positive about 523 -525 Marfleet Lane. We observed people and staff had developed good and caring relationships built on trust and mutual respect.

The provider had systems in place to safeguard people from abuse. Staff understood how to keep people safe. They recognised and reported any safeguarding concerns. Risk assessments were in place and medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks.

Staff were recruited safely and had the appropriate skills and knowledge to deliver care and support to people in a person-centred way. Some staff had worked at the service for a long time and this provided consistency for people.

Care plans contained relevant information about how to meet people's needs and were regularly reviewed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice.

People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks. People were treated with kindness and supported to express their opinion wherever possible.

People had access to a varied and balanced diet. Where required, staff monitored people's weights and worked with healthcare professionals to make sure people received medical attention when needed.

People and staff spoke positively about the registered manager. They felt able to raise concerns and were confident these would be addressed. Staff told us they were well supported by the registered manager and senior management team.

Checks of safety and quality were carried out to ensure people were protected from harm. Work took place to support the continuous improvement of the service and the registered manager was keen to make changes that would impact positively on people's lives.

No one was in receipt of end of life care however, staff had previously supported people at the end of their lives. They told us they were well supported by health professionals and should the need arise, would make the necessary arrangements to enable people to remain at home at this time.

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 1 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook this unannounced inspection on 12 May 2017. There were five people using the service at the time of our inspection. At the last inspection on 22 March 2016 we found improvements were required in the way information was shared, when issues were identified in recruitment checks, We also found the quality assurance system needed to be further developed to show what actions were taken where shortfalls had been identified within the service.

At this inspection we found the registered provider had taken action to address these issues.

The service had a registered manager. 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.

The majority of people who used the service had complex needs and were unable to tell us about their experiences. We relied on our observations of care and our discussions with staff and relatives involved. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who were unable to talk with us.

People who used the service had assessments of their needs undertaken which identified any potential risks to their safety. Staff had read the risk assessments and were aware of their responsibilities and the steps to minimise risk.

The environment was found to be clean and tidy throughout, and bedrooms were personalised in line with people’s preferences and personal interests.

Medicines were ordered, stored, administered and disposed of safely. Training records showed staff had received training in the safe handling and administration of medicines.

We found staff were recruited safely and there was sufficient staff to support people. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns.

Staff had access to induction, training, supervision and appraisal which supported them to feel skilled and confident when providing care to people. This included training considered essential by the registered provider and also specific training to meet the needs of the people they supported.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked the capacity to agree to it. When people were assessed as not having capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interests.

We found people’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. People who used the service received care in a person centred way with care plans describing their preferences for care and staff followed this guidance.

Menus were varied and staff confirmed choices and alternatives were available for each meal: we observed drinks and snacks were served between meals. Meals provided to people were varied and in line with risk management plans produced by dieticians and speech and language therapists. People’s weight was monitored and referrals made to dieticians when required.

We found staff had a caring approach and found ways to promote people’s independence, privacy and dignity. Staff provided information to people and included them in decisions about their scare and support.

People who used the service were seen to engage in a number of activities both within the service and the local community. They were encouraged to pursue hobbies, social interests and to go on holiday. Staff supported people to stay in touch with their families and friends.

There was a complaints process and information provided to people who used the service and staff in how to raise concerns directly with senior managers. Relatives knew how to make complaints and told us they had no concerns.

The service has a registered manager. 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.

We undertook this inspection on the 22 March 2016 and saw there were four people using the service. We decided to give a short notice period of 48 hours regarding the inspection, as some people who used the service accessed the community on a daily basis and we wanted to be sure people were in. At the last inspection on 6 October 2013, the registered provider was compliant in the areas we assessed.

The people who used the service had complex needs and were not able to tell us about their experiences. We relied on our observations of care and our discussions with staff and other professionals involved.

We found there was a quality monitoring system in place but this needed some improvements to make sure it was effective in identifying areas to improve and ensuring these were completed. A new system was currently being developed and when fully implemented should address the shortfalls.

We found new staff had been recruited safely and all checks had been completed prior to them starting work. However, we saw that when positive information was recorded on disclosure and barring service checks, these had not been communicated to the registered manager of the service so that risk analysis could be completed and management plans put in place. We have made a recommendation about this in safe and well-led sections.

Staff and rotas confirmed there were sufficient staff on duty during the day but since one of the bungalows has closed, there is only one member of staff on duty at night. When the second bungalow re-opens the issue will be resolved as a second member of staff will be on duty there. In the meantime, the registered manager told us this would be monitored to make sure there was no impact on the people who used the service and staff. We have made a recommendation about this. There was an on call system for emergencies.

We found medicines were stored securely and administered as prescribed to people. There were some recording issues which required improvements to make sure there was a good audit trail of why medicines were omitted and to ensure staff had clear guidance for some medicines which were to be administered ‘when required’. We have made a recommendation about this.

We found risk assessments were completed to guide staff in how to minimise harm during activities of daily living. There were also policies and procedures, and training, to guide staff in how to safeguard people from the risk of abuse. In discussions with staff it was clear they knew how to recognise abuse and how to report it to the appropriate agencies.

We saw people’s health needs were met. Staff kept a log of when people had contact with health professionals in the community. Staff followed advice about treatment plans the health professionals prescribed.

People’s nutritional needs were assessed and met. Meals provided to people were varied and in line with risk management plans produced by dieticians and speech and language therapists.

We saw people were supported to make choices about aspects of their lives when they were able to. Staff were clear about how they supported people to do this and in discussions they provided examples. We saw when people were unable to make major decisions, staff acted within the law and held meetings with relevant people present to decide a course of action in their best interest.

We saw staff had developed good relationships with people and it was clear they knew their needs well. Staff approach was kind and patient. Staff supported people to maintain family relationships.

People received care that was tailored to their individual needs and care plans provided staff with information about how best to support people in line with their known wishes and preferences. Reviews were carried out to make sure care plans were updated when required.

We saw people participated in activities within the service and staff supported them to access community facilities and to go on day trips and annual holidays.

Training was completed; records and staff confirmed there was sufficient training to enable them to feel confident when supporting the people who used the service. There was a system to identify when refresher training was due.

Staff told us they received supervision and support and could speak to the registered manager or senior managers when required. Annual appraisals were behind schedule but the registered manager was aware of this and had plans to complete them.

We saw there was a complaints policy and procedure which guided staff in how to manage them. The complaints procedure was also available in easy read for the people who used the service.

We found people received the care and support they needed. Each person had a care plan which detailed the support they required and how they liked to receive their support. The files we saw also outlined their preferences and any risks associated with their care. We saw people were involved in a variety of social and therapeutic activities both in the service and the community.

People who used the service were provided with a balanced and varied diet. Health professionals provided guidance and treatment when required.

The premises were in a good state of repair and were clean and fresh. A maintenance programme was in place and we found some people's bedrooms had recently been decorated.

Background checks had been carried out on staff before they started to work at the service to make sure they were suitable to work with vulnerable people.

We observed positive interactions between staff and people who used the service.

We saw the complaints procedure was available to people who used and visited the service. Staff told us how they would support people to raise concerns if they could not do so themselves.

We saw that when staff helped people they spoke calmly and provided clear information about choices and alternatives available. They were sensitive to people's needs and provided reassurance and guidance when needed.

We saw that people were safeguarded from abuse because staff had received training and there was guidance for staff to follow if they witnessed or became aware of anything.

We saw that staff had received adequate training which helped them to care for the people who used the service and to meet their needs.