Avenues South East - 74 Wilson Avenue

Updated 8 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 1 and 2 August 2018 and was announced. We gave the service short notice of the inspection visit because the location was a small care home and people are often out during the day. We needed to be sure that they would be in. The inspection was carried out by one inspector.

We used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We looked at information received from statutory notifications the provider had sent to us. A statutory notification is information about important events which the provider is required to send to us by law. We used this information to plan our inspection.

People who lived at the service had complex needs and were not able to tell us about their care and support. 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 could not talk with us. We spent time observing care and support in the communal areas. We observed how staff interacted with people who used the service. This helped us get an understanding of the care people received and to assess whether people's needs were appropriately met.

During the inspection we spoke with one visiting relative. We spoke with the regional director, registered manager, assistant manager and two care staff. After the inspection we spoke with two relatives on the telephone. We also contacted healthcare professionals who may have visited the service and Healthwatch to find out their views on the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We looked at four people's care records. We also looked at three staff files, including details of their recruitment and supervision. We reviewed duty rotas, training records, complaints and compliment and records relating to the management of the service, including quality assurance systems and processes.

Updated 8 September 2018

This comprehensive inspection took place on 1 and 2 August 2018 and was announced.

74 Wilson Avenue is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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 is registered to accommodate a maximum of six people with learning disabilities, physical disabilities and autistic spectrum. At the time of our inspection, there were five people living at the service. They had diverse and complex needs such as learning disabilities, cerebral palsy, autism, diabetes and limited verbal communication abilities.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection in March 2016, we rated the service Good overall. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At our last inspection, we made a recommendation because we identified a gap in the training schedule which showed that staff had not completed buccal midazolam training needed for the safe and effective administration of the emergency medicine. We rated the Effective question as Requires Improvement. During this inspection we found this issue had been addressed.

The service had a registered manager in place. 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.

People continued to receive safe care as they were supported by staff who knew how to protect them from harm. Staff were aware of people's individual risks and plans were in place to minimise these while maintaining people’s independence. Recruitment of staff was safe and robust. We

saw that pre-employment checks had been completed before staff could commence work. There were sufficient numbers of staff to support people to stay safe. Staffing remained flexible to suit the people living at the service and was arranged based on people's individual needs.

Staff received an induction when they started at the service and completed ongoing training to support them in meeting people's needs effectively. Staff had the right skills to provide the care and support that people required. Staff received supervision to support them in their role.

There was a safe procedure for managing people's medicines and people continued to receive their medicines as prescribed. Staff understood the importance of maintaining good infection control procedures to maintain the cleanliness of the service and minimise the risk of the spread of infection.

Systems were in place to assess people's needs before they started using the service to determine if their needs could be met. 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 support this practice.

People had support plans with detailed information and guidance personal to them to support staff in meeting their needs. Staff knew people's abilities, support needs and preferred routines and encouraged people to make their own decisions where possible. People had opportunities to engage in, and experience, different activities both inside and outside the service to support their mental, physical and emotional wellbeing. People were supported to maintain important relationships, which minimised risk of isolation.

There was a complaint procedure in place and information was provided to people in an accessible format, should they wish to raise a complaint.

We observed staff treating people with respect. Staff had a good understanding of how to promote people's privacy, independence and dignity. We saw staff interacting with people in a caring manner. Staff were patient towards people and we saw they were responsive to people's needs. Steps had been taken to promote people's right to confidentiality and people's spiritual and cultural wishes were respected.

People were provided with a choice of meals which took into account their likes and dislikes and were encouraged to eat a varied diet. People received support from health professionals in a timely manner when this was needed.

There were quality assurance systems in place to monitor the quality of service being delivered. The service regularly sought feedback from people and their relatives to help them monitor the quality of care provided. There were also regular audits of care and safety issues and checks were carried out to help ensure the premises remained safe. The provider notified us of significant events that occurred within the service. Where areas for improvement were identified, systems were in place to ensure lessons were learnt and used to improve the service delivery.

Further information is in the detailed findings below.