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Expect Limited - 1a Gainsborough Avenue Good


Inspection carried out on 4 January 2018

During a routine inspection

1a Gainsborough Avenue is a residential care home for three people with learning disabilities. The property is a dorma bungalow and has two bedrooms, a large and small lounge, kitchen and bathroom downstairs, with a further two bedrooms and toilet on the first floor. There is a large paved area at the front and rear of the building. There were three people living in the home at the time of the inspection.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

Risk assessments were in place specific to people’s individual needs and the activities they took part in.

Medicines were managed safely and people received their medicines as prescribed.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. There was sufficient staff on duty to meet people's needs.

The home was well maintained and in good decorative order. Measures were in place to ensure the environment was safe and suitable for the people who lived there. Repairs to the building were recorded and attended to in a timely way.

People's needs were assessed and care plans were completed to demonstrate the support required. People saw their local health care professional when they needed to.

Staff received a programme of mandatory training and regular supervision. Staff meetings were held to support staff in their role.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People made decisions and choices in relation to their care, support received and daily activities.

Staff knew people’s dietary needs and preferences. They supported people to eat and drink enough to maintain a balanced diet.

Staff showed kindness towards the people in the home. People were supported to maintain their independence with activities of daily living. People went out for social events and were supported to attend health appointments.

House meetings’ were held each month and enabled people living in the home and staff to discuss day to day issues and make plans for events, such as holidays. People made suggestions about places to visit or new activities they wished to try.

Care plans were written for the individual and informed staff of their preferences and wishes. These documents were regularly updated to reflect people's change in need or preference. People enjoyed a range of activities.

A complaints policy was in place but no complaints had been received.

There was a person-centred and open culture in the home. Staff reported that manager was approachable and supportive. Staff worked as a team and supported each other.

Quality assurance and governance systems were in place to help the registered manager and provider to monitor standards and drive forward improvements.

The registered manager and provider met their legal requirements with the Care Quality Commission (CQC). They had submitted notifications relating to incidents and the rating from the last assessment was clearly displayed.

Inspection carried out on 21, 22 & 24 April 2015

During a routine inspection

The inspection took place on 21, 22 and 24 April 2015 and was announced.

1a Gainsborough Avenue provides accommodation and support for up to three adults with a learning disability. The service is provided by Expect Limited. The property is a dorma bungalow and has two bedrooms, a large and small lounge, kitchen and bathroom downstairs, with a further two bedrooms and toilet on the first floor. There is a large paved area at the front and rear of the building. It is situated in a residential area convenient for amenities in Maghull.

There is a registered manager for the service. 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.

During our inspection we used a number of different methods to help us understand the experiences of people who lived at 1a Gainsborough Avenue. This was because some of the people who lived at the home communicated in different ways and we were not always able to directly ask them their views about their experiences. We spoke with two people who lived in the home about their experiences. Our observations showed people appeared relaxed and at ease with the staff.

People were kept safe because there were arrangements in place to protect them from the risk of abuse. Staff understood what abuse was and the action to take should they report concerns or actual abuse.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The manager informed us people who lived at 1a Gainsborough Avenue were supported to make key decisions regarding their care. We found the home manager knowledgeable regarding acting in people’s best interests. We saw this followed good practice in line with the Mental Capacity Act (MCA) (2005) Code of Practice.

Each person who lived at the home had a plan of care. The care plans we looked at contained relevant and detailed information. This helped to ensure staff had the information they needed to support people in the correct way and respect their wishes, likes and dislikes. A range of risk assessments had been undertaken depending on people’s individual needs to reduce the risk of harm. Risk assessments and behavioural management plans were in place for people who presented with behaviour that challenged. These gave staff guidance to ensure people’s safety when at home or out in the community.

Medication was stored safely and securely. Staff had completed training in medication administration. Medication administration records (MAR) were accurately kept to show when people had received their medication. Risk assessments were carried out for people who administered their own medication.

We looked around the building. We found it was clean and well maintained. Staff had a rota in place to ensure cleaning was completed daily. We found audits/checks were made regularly to monitor the quality of care provided and ensure it was safe and standards of cleanliness and décor were maintained.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Staff were only able to start work at the home when the provider had received satisfactory pre-employment checks.

We saw there were enough staff on duty to support people as needed in the home. This included support with personal care, to attend employment and take part in regular activities when they wished to. We saw the staff rotas which confirmed this.

Staff received an induction and regular mandatory (required) training to update their practice and knowledge. Records showed us that staff were up-to-date with the training. This helped to ensure that they had the skills and knowledge to meet people’s needs. Staff told us they felt supported in their roles and responsibilities.

People who lived in the home were supported to make their own drinks and snacks, with staff support. As well as indicating they wanted a drink or snack we saw staff asking them throughout the day. Staff had good knowledge of people’s likes and dislikes in respect of food and drinks. We saw that people who lived in the home had plenty to eat and drink during our inspection.

People who lived in the home took part in a variety of activities both in the home and in the community. Some people attended a day centre and enjoyed activities both in the home and in their local community.

During our visit we observed staff supported people in a caring manner and treated people with dignity and respect. Staff knew people’s individual needs and how to meet them. We saw that there were good relationships between people living at the home and staff, with staff taking time to talk and interact with people.

A procedure was in place for managing complaints There were no current complaints. We found that complaints had been managed in accordance with the home’s complaints procedure.

Systems for routinely monitoring the quality of care, support and treatment provided took place but were not always effective. The provider did not monitor the service to check improvements had been made to the quality and safety of the service.

Inspection carried out on 21, 23 May 2013

During a routine inspection

We visited the home on two occasions because on the first visit two people were at the day centre and the other person was going out later that morning.

On the second day of the inspection we were introduced to two people. One person had gone to the day centre; we spoke to them on the telephone the following day, to gather their views about the service.

People who lived in the home told us that they made day to day choices in their lives. One person told us of the activities they did each day, which involved attending the day centre. They told us of a recent holiday they had enjoyed with a relative. Another told us, �I love the staff, they�re great.� We asked one person if they had any complaints. They said, �Not at all.�

We looked at three people's care records in the office. We found them to contain relevant and current information about the people's needs.

On checking medication management we found that people received their medicines as prescribed. Records regarding medication were completed correctly.

We observed staff interacting with people who lived in the service during our visit. We observed some examples of where staff supported people well, such as acknowledging anxieties and attempting to reassure them.

Inspection carried out on 1 August 2012

During an inspection in response to concerns

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We observed staff assisting people when they requested support and accepting their decisions if they chose not to do something.

People's needs were assessed and care and treatment was planned and delivered in accordance with their individual care plan. We spoke with a person who told us how staff had supported them with what they needed.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw that people who lived at the house were very relaxed and confident around staff. This showed people felt safe in the home. Those spoken with were very relaxed around staff and said they were listened to so that any concerns were addressed.

There were effective recruitment and selection processes in place to ensure staff could

work with vulnerable people. We received positive comments about staff and their approach. One person said, "The staff are very good." Another said, �The staff are nice and lovely.�

People we spoke with told us that they were supported well by Expect Ltd and staff were always available to assist and help as needed.

People who used the service, their representatives and staff were asked for their views

about their care and treatment and they were acted on. All of the people we met with were living in accommodation that suited their needs. They told us they enjoyed living in the home.