We carried out a review of the data available to us about Avenues London (South) on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Avenues London (South), you can give feedback on this service.
Avenues London (south) provides personal care to 62 people with learning disabilities living in 22 different supported living schemes across South London and Kent. The schemes varied and included shared houses and individual flats. Some of the schemes had staff offices and were staffed 24 hours a day. Other schemes had different staffing arrangements depending on the needs of people living there.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People told us they felt safe and staff knew how to protect people from avoidable harm and abuse. People were supported to take medicines safely by trained staff. People told us they liked the staff who worked with them. There were enough staff, who were recruited safely, to meet people’s needs. People were supported to take risks, and there were robust risk assessments in place. We noted risk assessments were not always updated in a timely way when risks reduced. The provider had robust systems in place to respond to incidents and ensured lessons were learnt and shared.
People told us they were offered choices and their voice was clear in their care plans. Staff supported people to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not support this practice as they included unclear and unnecessary capacity assessments and described people as lacking capacity when all the evidence suggested they had capacity in that area. We have made a recommendation about applying the Mental Capacity Act 2005.
People were supported to access healthcare services, although records were not always easy to find. Staff worked well with different organisations involved in providing care to people. People were supported to prepare their meals and eat and drink a balanced diet. Staff received the support and training they needed to perform their role.
People, their families and other professionals were involved in assessing needs, writing and reviewing care plans. People’s views about their care were clearly captured and they had regular opportunities to provide feedback with their keyworkers. Plans were not always updated when people’s preferences changed, but their support was adapted in response to their feedback. People and relatives knew how to make complaints and were confident their concerns would be investigated. Staff had provided compassionate care to people at the end of their lives and the provider was developing training to increase confidence in supporting people to plan for the end of their lives.
People told us their staff were kind. We saw staff delivering compassionate and caring support. Staff treated people with respect and ensured their religious beliefs and cultural backgrounds were respected. People were supported to develop their skills and increase their independence.
The provider had taken on board our feedback from the last inspection. However, further improvement was needed to ensure consistency across all the schemes. The systems in place had not always identified the issues we found with the MCA and updates to care plans. The provider was developing their approach to engagement with families and worked closely with other organisations to inform their development. There was a clear plan in place to develop the services that ensured high quality support was central to the process.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
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
The last rating for this service was Requires Improvement (published 02 January 2018)
At this inspection we found improvements had been made.
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.
The service had 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 2008 and associated Regulations about how the service is run.
At this inspection we found that a number of improvements were required because, whilst the provider had taken appropriate action in response to any safeguarding concerns, one staff member had not followed safeguarding procedures and had failed to report an allegation of abuse. People were supported by trained staff to take medicines, but details about the support people required was not always clear in their support plans, and records showed staff provided medicines support to one person which was not part of their assessed needs or in line with the provider’s medicines management policy. Planned staffing levels have been determined based on an assessment of people’s needs, but sufficient staff had not always been consistently deployed as planned. The provider had systems in place to identify issues and drive improvements, but these were not always used effectively.
Whilst we received positive feedback about the management of the service from people we spoke with, two staff told us they did not feel they received adequate support from the management team and commented negatively about the culture of the service. We followed up on these concerns with the management team and noted that attempts had been made to offer support to staff through supervision and team meetings, and that where appropriate staff performance was being managed in line with the provider’s procedures. Staff had also taken action to make changes to the support they provided in response to the issues raised by the relative.
People’s needs had been assessed in line with their views and preferences. Risk management plans were in place where risks to people had been identified and staff were aware of the action to take to manage identified risks safely. The provider reviewed information regarding any accidents and incidents that had occurred and took action to reduce the risk of future occurrence. They followed safe recruitment practices and supported staff through regular training and supervision.
People were protected from the risk of infections because staff had received training in infection control and food hygiene, and were aware of the steps to take to reduce the risk of the spread of infections. We observed staff following safe infection control practices. People were supported to maintain a balanced diet and were involved in decisions about what they ate. Staff were aware of the support people required to prepare and eat their meals, and supported them accordingly.
Staff were aware of the importance of seeking consent from the people they supported and demonstrated an understanding of the Mental Capacity Act 2005 and how it applied to the support they gave people to make decisions. 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 were also supported to maintain good health. They had access to a range of healthcare services, and healthcare professionals we spoke with told us staff worked well with them to deliver effective care and treatment.
Staff treated people with care and compassion. People were involved in making decisions about their care and treatment and had access to advocacy services where appropriate. People told us staff treated them with dignity and respected their privacy, and we observed staff treating people respectfully during our inspection. The provider had a complaints policy and procedure in place and people told us they knew how to complain.
People received personalised care that reflected their individual needs and preferences. They were involved in the planning of their support and had meetings with their keyworkers on a regular basis to ensure their needs were being met and support plans were up to date. Staff supported people to maintain relationships with family and friends, and to take part in a range of activities in support of their interests and need for social stimulation.
The provider also sought people’s views on the service through meetings and regular surveys. The outcome of the last service indicated the people were happy with the service they received and were experiencing positive outcomes.
This is the first time the service has been rated Requires Improvement.
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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
This was an announced inspection to ensure the registered manager was available at the time of the inspection. At our previous inspection in June 2013, the provider was found to be meeting the required standards in the following areas; respecting and involving people who use services, care and welfare of people who use services, safeguarding people from abuse, staff support and supervision, and how the quality of the service was monitored.
Avenues London (South) provides personal care and support for people with learning disabilities and complex needs living mainly in supported living accommodation with some domiciliary care services within South London. In the London borough of Sutton, the provider has a specific scheme which provides innovative support, mainly of hospital admission avoidance for people with dementia. At the time of our inspection, 167 people were using the service in the London boroughs of Bromley, Greenwich, Merton and Sutton.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
People and their relatives were complimentary about the service and told us they would recommend the service to their friends and families. People told us that staff were caring, friendly and welcoming. We observed positive interactions between people and staff and we saw that relationships between people and staff were open and trusting.
People informed us that staff had time for them and did not rush them when providing support. Where possible, people, their relatives and those that matter to them were involved in making decisions about their care and support, and their views were acted upon. People said they felt staff provided the support they needed and they had nothing to complain about.
People’s support plans were detailed and written in formats to support people’s understanding. The support plans addressed people’s individual needs and provided staff with guidance on how to support each person appropriately in a safe and dignified way.
People had access to healthcare services and received on going healthcare support. The service worked in cooperation with other agencies and services to make sure people received effective care and support when required.
There were systems in place to identify, assess and manage risks to the health, safety and welfare of people, including safeguarding people from the risk of abuse.
Staff said the management team were approachable and they felt supported to perform their duties as required. Staff knew the support needs of people and told us how these needs were met.
We found that people and their relatives were able to express their views and were involved in making decisions about the care and support provided. People who use the service had a care and support plan with relevant risk assessments in place. Staff we spoke with knew about safeguarding vulnerable adults and their responsibility to protect people from abuse. Support was in place for staff through induction, supervision, team meetings and training. There were systems in place to assess and monitor the quality of the service that people received.
We reviewed all the information we held about this service and carried out an unannounced visit to their office on 28 June 2012. We looked at the records of people who were using the service, care workers records and talked to senior staff and people who use the services. We visited seven people in their own homes on 29 June 2012 and we spoke to them in order to get their views about the service. An Expert by Experience carried out telephone interviews with 12 people using the service.
All the people we spoke with told us that the care workers always spoke with them appropriately and used the name they preferred. One person said they are 'special'. People told us that the door was always closed when personal care was being given to prevent anyone walking in.
We saw that care workers made a written record of what they had done during their shift. This information served to provide additional information for any care worker that was not familiar with the person's needs. Everyone we spoke with told us that they received the care they needed and wanted at a time that suited them. One person told us 'I am happy' and 'respected'. Another person told us 'Any changes to my services are discussed with my support worker and the manager'. For example, some one asked for a change of the care workers and the agency acted upon in a timely manner.
All the people we spoke with told us that they felt safe using the service. They told us that care workers behaved appropriately when providing care and support to them. For example, one person told us they help me get 'independent'.
People told us that they knew how to complain about the care and support they received if they needed to. For instance, one person told us 'I am not abused in any way my belongings were being looked after and nothing goes astray'. Another, person told us care workers were 'nice' and 'good'.