Archived: 7-9 Third Avenue

About the service

7-9 Third Avenue is a small care home providing care and support to people with a learning disability and autistic people. The property is a 6 bedroomed bungalow and there were 6 people living at the service at the time of the inspection.

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

Right Support:

The provider did not always ensure people were supported to have the maximum possible choice, control and independence. People’s care plans and daily records lacked information about how staff supported people to engage with meaningful activities and achieve goals.

Staff supported people with their medicines in a way that promoted their safety and achieved the best possible health outcome. Staff supported people to maintain their health and wellbeing.

Right Care:

The provider had not always promoted opportunities for people to try new activities that enhanced and enriched their lives.

Staff had not always received specialised training to understand people’s individual communication methods. However, staff were able to tell us how people liked to interact and the methods they used to communicate.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough staff to meet people’s needs and keep them safe. People received consistent care from staff who knew them well.

Right Culture:

The culture of the service was not always positive and staff did not always understand best practice in relation to the wide range of strengths and needs people with a learning disability and autistic people may have.

The provider did not always have effective oversight over the quality and safety of the care people received.

People and those important to them, were not always actively involved in planning and reviewing their care.

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 02 August 2017).

Why we inspected

We undertook this focused inspection to assess whether the service was applying the principles of right support, right care, right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This report only covers our findings in relation to the Key Questions of Safe, Responsive and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 7-9 Third Avenue on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of safety and oversight of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The registered manager was following the government's guidance on whole home testing for people and staff. This included using rapid testing, weekly testing for staff and monthly testing for people who used the service.

¿ Staff had received training on working during the pandemic in relation to COVID 19 and had received training in the correct use of personal protective equipment (PPE).

¿ The communal areas were open plan which enabled people to socially distance where possible. However, people had found it hard to change their routines and still choose to eat and socialise together.

¿ There was clear guidance in the service to help prompt staff to safely work whilst minimising the risk of spreading infection.

¿ Infection prevention control practices had been implemented such as increased cleaning rotas and a good supply of PPE and hand sanitisers. Information was cascaded to staff and reminders issued. Audits and observations were completed and actions taken to improve the service.

¿ People's well-being was supported by going out for exercise, to see relatives (in open spaces) and telephone and zoom calls. Staff continued to engage in individual activities of people's choice.

We carried out an unannounced inspection of 7-9 Third Avenue on the 6 and 7 June 2017, to see if the provider had made the necessary improvements to the service. Records showed that improvements which were in progress at the last inspection had been completed. The service was given a rating of ‘Good’.

7-9 Third Avenue is a small residential home providing intensive support for people who have learning and physical disabilities. The property is a six bedroomed bungalow and there were six people living at the service at the time of the inspection.

There is a registered manager at this location. 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 knew how to protect people against the risk of harm and abuse. Risks to people’s health and wellbeing were assessed in order to minimise them and ensure people maintained their independence. People were given their medicines in a safe and timely way.

Staffing levels in the service were appropriate to meet people's needs. Staff members did not start to work at the service until satisfactory employment checks had been completed

A programme of induction, training, supervision and appraisals for staff were in place and they had the knowledge and skills to care for people effectively. Specialist training was now being provided to staff.

Systems were in place to ensure that people’s rights were respected and protected under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People had as much choice and control in their lives as possible and were supported in the least restrictive way.

People enjoyed their meals and the food and drinks provided. They were involved in choosing what to eat and drink and going shopping for the household groceries. Their health needs such as their weight and fluid input were now recorded. Health and social care professionals provided specialist input for people and referrals for support were made in a timely way.

People used a range of ways to communicate and express themselves. Staff were aware of their verbal and non-verbal communication, sounds, signs and facial expressions to understand their feelings. People were relaxed and cared for by kind and friendly staff.

Feedback was obtained from people who used the service, their families, representatives and staff about the quality of the service and this was used to improve the service. People knew how to make a complaint and we saw that complaints had been dealt with appropriately.

Systems to monitor the quality of the service had been improved by implementing regular audits and better recording of information so that people received care and support of good quality.

7-9 Third Avenue, is a small care provider providing intensive support for people who have a learning disability. The property is a six bedrooms bungalow and there are six people living at the service. All rooms have level access to the outside garden area.

There is a registered manager at this location. 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.

We found that, people were supported to make choices about the support and care they received and staff were kind and respectful. People had access to healthcare professionals, including the GP, optician and chiropodist.

We found that staff had not always completed a thorough induction and had not received the training they needed to understand how to meet people’s needs. Staff told us that they were supported by their registered manager and received supervision. We found that staff did not consistently receive an appraisal of their work and did not understand the vision and values of the provider.

Medication was managed safely and staff members understood their responsibilities. Since returning to manage the service the registered manager had recently reintroduced medication audits.

People were regularly asked by staff if they were happy and how they wanted to be supported. People had their needs and requests responded to promptly, and were asked to give their consent before care was carried out. We found that consent was not always recorded within the care records.

Staff members understood the principles of the Mental Capacity Act 2005 (MCA) and were able to describe their responsibilities to seek the consent of the people they supported. When people were thought to lack mental capacity the provider had taken the appropriate action to make sure their care did not restrict their movement and rights under the MCA. Decisions about the care people received were made by the people who had the legal right to do so.

We saw that people had developed caring relationships with the staff that supported them. Family members told us that people were encouraged to take part in a range of activities if they wanted to, and we found that people’s independence was promoted. We found people had enough to eat and drink to meet their needs. Some people required specialist diets and staff told us they would benefit from additional training to support people to eat safely.

The arrangements to cover the absence of the registered manager did not provide consistent leadership and direction for staff. The service has had several registered managers and there has been an inconsistent approach to management.

Surveys to get views about the service was not always obtained from people, staff, visitors and families, so this information could not be used to help drive continuous improvements. Staff told us that if they had a concern they could raise this on an informal basis and the manager would listen to them. We noted that a new quality assurance system had been introduced to identify areas for improvement, feedback had not yet been obtained from people, staff, visitors or families. Staff members were unclear about what the vision or values of the service was.

We found that there were some breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we have told the provider to take at the back of the full version of the report. The overall rating for this provider is ‘Requires Improvement’.

We spoke with six staff. We reviewed three people's care planning files and three staff personnel files. We found systems in place for effective staff recruitment.

There were procedures for staff to follow for infection control and to keep people safe. The provider had systems in place for gaining the consent of people or others involved in their care before carrying out tasks.

We observed positive, caring interactions from staff during our visit and saw that staff were responsive to people's needs. There were processes in place for people or others to make complaints or give feedback on the service and for a response. We found that an interim manager was in place and recruitment for a new manager was in progress.

People's diversity, values and human rights were respected. We looked at a sample of support plans and they contained good information about the individual's needs, wishes and choices. They included information on the person's cultural and spiritual needs where known. People appeared relaxed and happy in staff's company. We observed staff treating people in a respectful and dignified way.

We looked at the system used for safeguarding vulnerable adults. There was a policy and a procedure in place and all of the staff had received training. Staff spoken with had a good knowledge of the signs of abuse and clearly described the reporting procedures.

The records showed that staff had received regular supervision and training. Staff told us that they felt well supported to do their work. The provider had carried out regular monthly monitoring visits and had prepared a report of their findings. Actions had been carried out as required in the report. The manager had completed regular audits of the home's systems and practices.

The manager was not able to tell us when the last quality assurance survey had been carried out. They told us that none had taken place since they took up their post in October 2010.