Archived: Park Avenue Residential Home

This inspection took place on 3 and 4 November 2015 and was unannounced.

Park Avenue Residential Home is registered to provide residential care without nursing for up to 25 younger people with a mental health diagnosis. The service is comprised of two Victorian houses number 74 and number 76, each house accommodates a mix of male and females and has shared bathroom facilities. The two houses are not joined but have communal access to gardens and a shared parking area at the rear of the properties. People are able to move freely between the two houses. At the time of the inspection there were 21 people living at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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.

Staff did not always demonstrate that they had the required knowledge to be able to safeguard people and report all concerns to the relevant safeguarding authority. Staff had been trained in how to identify and report safeguarding situations. However one incident had not been reported to safeguarding as the person it concerned did not want it reported. Staff had not understood they could override a person’s choice if there was a significant risk to themselves or other people as a result of not reporting concerns. Although action had been taken to safeguard other individuals living at the location following incidents, there had been a failure to review safeguarding incidents at an overarching service level. This was required in order to identify any themes or further action required across the service to keep all people safe from the risk of abuse. As a result people subsequently alleged they had been abused by other people within the service.

People were not always supported by staff who had been provided with sufficient information to be able to meet their needs safely. The pre-admission process was not sufficiently robust to ensure decisions to admit people were always based on the full range of information available. The provider had not always taken into account people’s personal histories when deciding whether they could safely accommodate people and manage the potential risks to them or others. People’s risk assessments were not always thorough to ensure risks to them and others were managed safely. This had led to people experiencing harm.

Records showed that there were not enough staff employed to ensure the staffing roster based on the historical staffing level for the service was always fully covered. There were not always enough staff to ensure there could be two waking night staff one for each house at night to ensure people’s safety. There were insufficient staff to ensure that people’s needs were being met safely. People, a community psychiatric nurse and two social workers told us there were not always enough staff. People told us there were not always enough staff at weekends to support them to participate in meaningful activities. Records also showed that there were not enough senior staff employed to ensure there were always senior staff deployed on each shift to provide advice, guidance and support to staff. There were not sufficient staff employed or deployed to meet people’s needs safely.

Medicines were not always managed safely. Some prescription medicines are controlled under the Misuse of Drugs Act 1971; these medicines are called controlled drugs or medicines. The provider had not ensured that robust records had been kept for controlled drugs. Medicine audits had been completed but there was a lack of related action planning to manage the risk of reoccurrence. People had medicine risk assessments in place. However, these did not always take into account the risks medicines could pose to individuals and ensure identified risks were managed safely. Procedures for the administration of ‘When required’ medicines did not ensure clear, sufficient information was available for people to take them correctly and consistently in response to their individual needs. When required medicines are those which are not consistently used by people and can include pain relief medication.

People did not always receive food which had been stored appropriately. Staff had not always fully followed food safety guidance to ensure people’s food was handled safely and the risk of bacterial growth minimised.

Staff had undergone an induction to their role and were supervised in their work. However, people living at the location had diverse and complex mental health diagnoses. Some had a secondary diagnosis of a learning disability or a personality disorder. Other people had a forensic history, this is when a person with a mental health issue has been arrested, is on remand or has been to court and found guilty of a crime. A staff member told us they had requested additional training in forensics but this had not been arranged. Other people had a history of drug or alcohol misuse. Not all staff had received relevant training in relation to mental health, personality disorder, drug and alcohol misuse, forensics and learning disabilities to enable them to meet people’s needs effectively.

People were subject to restrictions upon their movements, such as the times they could access the kitchen, the fridges were locked and people could not watch the communal televisions before 17:00. Although these did not amount to people being deprived of their liberty. There were generalised practices in place which were not underpinned by robust risk assessments to demonstrate either why they were required or that people had been consulted about their use.

People provided negative feedback about the quality of the meals provided. People had to choose their meals five weeks in advance rather on the day or the day before which would have enabled them to make meaningful choices. The meals served to people did not take into account their dietary needs or preferences regarding portion size to ensure they received an appropriate amount of the right type of foods to meet their nutritional needs.

The provider had not always considered how practices within the service impacted upon people’s rights to privacy and dignity. People were accommodated within mixed sex accommodation with shared access to bathroom facilities. People’s need for privacy and dignity had not always been met.

The processes for auditing the quality of the service had not been effective. Audits had been completed in October and December 2014 but no action had been taken until they were provided to the registered manager on 28 July 2015. The audits had not identified the issues found at this inspection.

People’s records were not complete and contained insufficient information to demonstrate how decisions to admit people had been reached and their suitability for the placement. Some people’s care plans contained insufficient information for staff about the support they required and how this was to be provided.

There was a lack of a clear documented vision of the service in terms of who they accommodated and the type of service offered. The provider had admitted people with very diverse needs which made it challenging for staff to safely and effectively meet everyone’s needs. The provider’s values had not been consistently applied within the service as a result risks to people had not always been managed.

People told us staff supported them to see healthcare professionals as required.

People told us they were involved in planning their care. The registered manager had just introduced weekly keyworker meetings to support people with weekly goal setting. However people’s records did not always fully document people’s involvement in their care planning.

People’s needs had been assessed and re-assessed and where possible people had been supported to develop their independence with a view to moving to other more independent living accommodation. Staff supported people to measure their recovery and to develop crisis plans. People were supported to access a range of community activities. Although there was a structured programme of activities people told us they did not always receive sufficient stimulation at the weekends.

Resident’s meetings had been held, however these were led by staff and people did not have full control of the meeting or the agenda to ensure it was fully run by them and reflected their priorities.

Feedback regarding management and leadership was positive. However, for the size of the service and the complexity of people’s needs there was insufficient management time allocated to address all of the issues within the service. The registered manager had only received a minimal amount of formal supervision from the provider to support them in their role.

The service worked with a range of other services for the provision of people’s care. However, the provider had not always received a consistent level of support from mental health services in order to ensure people’s changing needs could always be met.

Most staff had undergone training in the Mental Capacity Act 2005. Where staff had identified people lacked the capacity to make a specific decision about their care they had made arrangements for the person to receive an assessment of their mental capacity.

Staff had undergone relevant pre-employment checks to ensure they were of good character and suitable to work with people.

People we spoke with all gave positive feedback about their relationships with staff. People told us staff were good to them and supportive. People benefited from continuity of staffing and staff understood their care needs.

People had been provided with information about their rights within the service. People’s permission was sought before information was shared about them. People were consulted about the content of the fortnightly activity schedule and asked for their ideas for activities.

Processes were in place to enable people to make a complaint about their care if they wished. Complaints had been investigated and responded to appropriately.

During the inspection, we identified a number of serious concerns about the safety and welfare of people who received care from the provider. We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.