Archived: Avenues South East - 69 Reigate Road

ASE - 69 Reigate Road provides accommodation for up to six people with a learning disability such as autism. Some people also had visual problems. At the time of the inspection six people were living at the service. The size of the service meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

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

People were cared for by staff who showed a caring and attentive approach towards them. Staff knew people well and this was clear though the interactions between people and staff. People were enabled to access activities both within and outside of the service.

People lived in an environment that was suitably adapted for them, however we noted some areas which looked worn and as such may not be easy to clean. The service was currently undergoing redecoration which would address this.

People received the medicines they needed although we found that one person had no pain patch records to demonstrate their medicine was applied appropriately. The registered manager told us they would remedy this.

People were helped to stay safe through the information in their care plans, the actions from staff and the risk assessments that had been developed. However, we found the registered manager had not reported two incidents of potential abuse to CQC in line with their statutory requirements. We have made a recommendation to the registered provider in this respect.

Staff had undertaken some detailed work in response to people’s needs, such as supporting someone to start making their own decisions and another person to undergo a surgical procedure with the least discomfort to them. Staff were continually looking at ways to improve the service and provide the best care to people.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied. 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 (and update)

At the last inspection in September 2016, we gave the service a rating of Good (published 4 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence 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.

There was not 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 and associated Regulations about how the service is run. A new manager had taken up their role in July 2016 and was in the process of registering with the Care Quality Commission. The new manager assisted us with our inspection.

People’s relatives told us they felt the service was safe. Relatives told us that staff were very kind and they had no concerns in relation to the safety of their family member. Staff had received training in relation to safeguarding and they were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse.

Staff had received training, regular supervisions and annual appraisals that helped them to perform their duties. New staff commencing their duties undertook the Care Certificate training to help prepare them for their role.

There were enough staff to ensure that people’s assessed needs could be met. It was clear that staff had a good understanding of how to attend to people’s needs.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way

People were not prevented from doing things they enjoyed as staff had identified and assessed individual risks for people. The manager logged any accidents and incidents that occurred.

The provider ensured that full recruitment checks had been carried out to ensure that only suitable staff worked with people at 69 Reigate Road.

People lived in a homely environment that had been adapted to the needs of people. Everyone was involved in maintaining the upkeep of the home by taking part in the cleaning and general housework duties.

People were encouraged and supported by staff to be as independent as they were able. Staff supported people to eat a good range of foods. Those with a specific dietary requirement were provided with appropriate food. People were involved in preparing food and shopping.

People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private. People took part in a variety of activities that interested them.

Documentation that enabled staff to support people and to record the care they had received was up to date and regularly reviewed. People’s preferences, likes and dislikes were recorded.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place. People would be evacuated to local hotels should the need arise. There was an on-call system for assistance outside of normal working hours.

A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were attended to by staff.

Relatives and associated professionals had been asked for their views about the care provided and how the home was run. Regular staff meetings took place.

As part of our inspection we spoke with staff, other health care professionals and relatives of the people who lived in the home. We were unable to speak with the people who used the service because of their complex needs, so we used observation to inform our judgements.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found during our inspection that people were cared for in an environment that was safe, clean and hygienic. We found the building fresh, clean and generally well maintained.

We noted that the provider has ensured that where people lacked capacity to give their consent a mental capacity assessment had been carried out.

We spoke with two health care professionals who told us 'Whenever we arrive we are met at the door and asked to sign in. If another member of staff see's us in the home, they always check who we are and why we are here.'

Is the service effective?

We were unable to speak to people who used the service, but it was clear from our observations and from speaking to staff that they had a clear understanding of people's needs. It was evident that they (staff) knew people's needs well. People who used the service appeared calm and content. A relative we spoke with told us they had seen changes in their family member since they had lived at 69 Reigate Road.

Is the service caring?

We saw that people were supported by kind and attentive staff. We saw during lunch that staff supported people to eat at a pace that suited them. One relative we spoke with told us 'I would have no hesitation in awarding them 9 out of 10.'

Is the service responsive?

People who used the service had a keyworker who regularly reviewed the needs of the person. We observed during our visit that one person had a new wheelchair to allow them to sit more comfortably and upright. This had been arranged by the staff.

Is the service well-led?

Staff that we spoke with told us that they were encouraged to make suggestions with regard to improving the service and the care of the people who lived in the home. We saw that relatives and health care professionals were asked to complete a stakeholders questionnaire.

We observed staff had a good knowledge of people's needs and communication methods and demonstrated this through their positive interactions with the people who use the service. For example, they were observed guiding people when needed in the manner they preferred as recorded in their plans of care, entertaining people when they showed the need and being responsive and happy.

We saw there were no obstructions on the floor such as frayed carpet and that people who used the service were free to move around the building and confident to move between walls or rails used for guidance.

We saw that staff did offer choices and seek consent before offering care, and information was included in formats and languages people would understand better so the person's consent would be better informed. However, where people did not have capacity the provider did not always act in accordance with legal requirements in seeking consent to care, medication and invasions of their right privacy.

We noted people experienced care, treatment and support that met their needs and there were contingency procedures in place to plan for all foreseeable emergencies. This meant that if an emergency situation did occur there would be procedures known to staff to mitigate the risks that may arise.

We found that although the building was fresh, clean and generally well maintained, people who used the service were not always protected against the risks of unsafe or unsuitable premises because the provider did not ensure windows were robust and fit for purpose so that window restrictors would function safely, and did not keep keys safely or according to assessment, and did not ensure people were protected from live electrical connections at hand level.

We also found that files containing information about staff were kept securely and confidentially, but the same level of privacy and confidentiality and compliance with the data protection act was not offered to the people who use the service.

The service provided safe, appropriate care, through carrying out initial assessments and planning care based on collating all the required information and making decisions based on people's choice and risk assessments.

The relatives of the people who used the service told us that their relatives were looked after well, "the staff kept them informed and it was like a little family".

We saw that the provider minimised risk and the likelihood of abuse by making sure all the policies and procedures to promote safeguarding were in place.

We saw that the home had the most recent local authority safeguarding procedure in place. We spoke to staff who were aware of safeguarding procedures, and all had recent training or refreshers in this area.

The manager told us that the service conducts quality audit (QA) surveys every year. One relative told us that they had been asked to provide feedback about the service and to comment of the way they found the service was meeting the needs of their family member.