We carried out a review of the data available to us about The Avenue on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Avenue, you can give feedback on this service.
The Avenue is a residential care home providing personal and nursing care to three people with learning disabilites at the time of the inspection. The service can support up to three people.
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
The leadership and team working within this service was exceptional. This ensured everyone received high quality and personalised support. The history of this service showed the registered manager, service manager and the staff team worked in partnership to continuously improve and this achieved the best outcomes for people. Everyone without exception, praised the leadership and compassionate approach within this service. Staff were responsive to people's needs, whilst supporting them to learn new skills to improve their health and well-being. Health professionals described the service as; "Superb" and "They are pretty special."
People received care and support that was truly individualised, flexible and responsive to their needs. We received overwhelming feedback of the positive impact this had on people and how they had changed people’s lives. We saw excellent examples of how the care and support people received enhanced and enriched their lives. Staff had the upmost respect for people's individuality and empowered them to express their wishes and make their own choices. People and others knew how to feedback any concerns or complaints about their experiences and were extremely confident about doing so.
Professionals and family members were extremely positive about how kind, caring and compassionate staff and managers were. Staff were highly motivated in providing consistent person-centred care. Relatives told us they felt they and their loved ones were listened to, valued, respected and included in every aspect of their care and support, and the development of the service. People’s independence and choice was promoted to the maximum and they were consistently supported to develop new skills. The registered manager and staff had formed strong trusting relationships with people and were described as often going above and beyond what was expected of them to enhance and enrich people’s quality of life. The registered manager, service manager and staff had been very compassionate in the way they supported people at the end stages of their life and after their death.
Staff received regular training, repeated induction programmes to keep their knowledge up to date, received supervisions, attended staff meetings and had regular practice checks. Staff we spoke to said that they felt very well supported and valued.
Accidents and incidents were managed appropriately and referrals were made to other professionals in a timely way when people living in the home were in need. Each relative we spoke with had no complaints and were very happy with the service being delivered.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 27 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.
The Avenue provides care and support for up to three people who have a learning disability close to the centre of Darlington.
The service had a registered manager in place. 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 2008 and associated Regulations about how the service is run.
We last inspected the service in December 2014 and rated the service as ‘Good.’ The domain of well-led was rated ‘Outstanding’ in December 2014 and remained ‘Outstanding’ at this visit.
The service specialises in providing person centred care and support. In the last two years it has supported two people using the service who had lived there for over twenty years to pass away peacefully at The Avenue as they wanted, with the support of their families and with successful multi-agency working.
The registered manager pro-actively worked with all agencies to ensure people’s choices were upheld and that the staff team went above and beyond to tenderly care for people at the end of their life in a manner that promoted their dignity.
Feedback from relatives and professionals was exceptional. The community matron, learning disabilities liaison nurse and the service’s GP all gave lengthy feedback to the Care Quality Commission. The GP wrote, “The Avenue showed care beyond what is normally observed from family members. It has been a complete privilege to work with this team.”
The registered manager continued to lead by example, ensuring they worked alongside staff members and ensuring that people’s needs were at the fore front of all activities and planning for the service. On the day of our inspection visit the registered manager had been shopping for people as they were taking everyone living at the home on holiday for a week.
There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. The registered provider ensured that staff were provided consistently even employing staff who had worked with someone moving into the service to ensure an effective transition.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.
The home was clean and suitable for the people who used the service and appropriate health and safety checks had been carried out.
Risk assessments were in place when required and accidents and incidents were appropriately recorded and analysed by the registered manager and service manager.
Appropriate arrangements were in place for the administration and storage of people’s medicines.
Staff received regular supervisions and appraisals. Staff training was up to date and each staff member had a personal development plan to ensure their learning needs were met. Staff had mandatory training to ensure they were working safely but also specialist training such as autism and cancer awareness.
Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.
People who used the service were consulted about activities and interests, and activities were arranged based on people’s likes and interests and to help meet their social needs.
The registered provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.
The service had excellent links with the local community and local organisations.
Staff told us they felt totally supported by the management team and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.
The inspection visit took place on the 18th December 2014 and this was unannounced.
We last inspected the service on 17th December 2013 and we found that the service was meeting the requirements of the regulations at that time.
The Avenue provides care and support for up to three people who have a learning disability. The home does not provide nursing care. There were currently two people living at the home who have been there since it opened eighteen years ago. All but two of the staff team have also worked at the home for over ten years. The home is in the suburbs of Darlington and close to public transport and shops.
There is a registered manager in post. 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.
There were policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards (DoLS). The registered manager had the appropriate knowledge to know when an application should be made and how to submit one. This meant people were safeguarded.
We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people using the service such as epilepsy and palliative care. There were sufficient staff on duty to meet the needs of the people and the staff team were very supportive of the manager and of each other. Staff had been employed at the home for a long time at this home ensuring a stable staff team. Medicines were stored and administered in a safe manner.
There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development. Staff told us they felt very supported by the management of the home.
We saw people’s care plans were person centred and were derived from thorough assessments. The home had developed easy read care plans to help people be involved in how they wanted their care and support to be delivered. We saw people being given choices and encouraged to take part in all aspects of day to day life at the home, from going to the cinema to helping make drinks. One person who was in the process of transitioning to the home had an excellent transition plan in place.
The caring nature of staff and the registered manager were highlighted by the comments and feedback we received and saw from visitors, relatives and healthcare professionals following the death of one person who lived at The Avenue. Staff were committed to providing this person with one to one support throughout their time in hospital and advocated on behalf of the person to bring them home to receive palliative care with the support of other agencies. This person was thought of as part of the family at The Avenue and the dedication of staff to meet their wishes at the end of life whilst supporting other people at the home sensitively and with dignity was highly commended.
The service encouraged people to maintain their independence and people were supported to be involved in the local community as much as possible using public transport and accessing regular facilities such as the local G.P, shops and leisure facilities.
The service undertook regular questionnaires not only with people who lived at the home and their family but also with visiting professionals. The comments made by healthcare professionals who worked with the home following the illness and passing away of one person who lived at The Avenue were excellent. We also saw a regular programme of staff meetings where issues where shared and raised. The service had an easy read complaints procedure and staff told us how they could recognise if someone was unhappy. This showed the service listened to the views of people.
The service ensured that people were supported to have their nutritional needs met by using photographs to help people make food choices and the home also sought professional support from dieticians.
The service had a robust quality assurance scheme that checked how people living at the home and their families felt about the service they received. The home also checked the environment regularly to check people and staff were working safely.
People were supported to make complaints if they were unhappy and the service used easy read information to make this process accessible.
Staff members on duty were observed speaking to people in a kind and respectful way. We also observed the people living at The Avenue were clean and well groomed. We asked one person, who lived at the home, about their plans for the day and they told us that they were going out with staff to the theatre.