Roseneath Avenue

About the service

Roseneath Avenue is a residential care home providing personal care for up to 6 people living with a learning disability and/or autistic spectrum disorder. At the time of the inspection, there were 6 people living at the home. Each person had a large flat within the home consisting of a bedroom, living and kitchen area and a bathroom and contained everything the person needed to live independently.

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

Right Support:

People were supported by staff to pursue their interests. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their needs. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcomes. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this. At the time of the inspection, there was a high usage of agency staff. We found concerns around the lack of training and supervision regular agency staff.

Right Care:

Staff had training on how to recognise and report abuse. However, we found some concerns around how safeguarding issues were identified and managed. Whist staff had training around safeguarding, we found safeguarding concerns were not always identified and managed appropriately. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People who had individual ways of communicating, using body language, sounds, pictures and symbols could interact comfortably with staff and others involved in their treatment/care and support because staff had the necessary skills to understand them. People’s care, treatment and support plans reflected their range of care and support needs.

Right Culture:

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

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 21 December 2018)

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and staffing. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

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

Enforcement

We have identified 3 breaches of regulation in relation to managing safeguarding concerns, ensuring regular agency staff were appropriately trained and supported and the governance of the home.

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.

The home is registered to accommodate six people in self contained flats. Each person has a large flat within the home consisting of a bedroom, living and kitchen area and a bathroom. The flat contained everything the person needed to live independently. The home also had a garden area that people had to access to.

The care service had 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 life as any citizen.

We found the following examples of good practice.

The home had responded to peoples’ choices and individual needs during the pandemic to help them carry out activities outside the home safely. For example, ensuring lateral flow testing each day before they leave the home and providing masks to take with them.

The provider had admitted a new service users to the home during the Covid 19 pandemic. Risk assessments were in place to ensure a safe transition would be achieved. This included adhering to current national guidelines, a test before entering the home, period of isolation and then a further test at the end of the isolation period. Staff carried out regular welfare and mental health checks throughout the isolation period.

The staff were aware of who to contact should they have an outbreak of Covid 19 and the protocols to follow.

The provider did not place any restrictions on the number of visitors that service users had but they needed to book in before coming. Visitors had to either provide proof of a recent registered lateral flow test or carry out a test at the main entrance before entering the premises. Visits took place in the individual service users flat.

The home had sufficient supplies of Personal Protective Equipment (PPE). There were PPE stations in each of the flats and at the front entrance. Staff had received training in infection prevention and control and how to don and doff PPE.

Easy to read guidance information was used to help explain situations relating to the pandemic. For example, how to identify symptoms, how to test and what Covid 19 is.

The provider had a system in place to ensure staff had the necessary vaccinations and had completed the necessary Covid 19 testing prior to working at the home.

All residents and staff had received the Covid 19 vaccination.

There was one small communal area that was mainly used by staff as service users had their own space inside their flats. The premises looked clean and hygienic throughout. There were cleaning stations in place and adequate ventilation.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

At our last inspection on 27 June 2017 the service was rated ‘Requires Improvement’. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12 which related to some staff being unable to explain what safeguarding meant and how to report any concerns appropriately, understanding the purpose of people’s behaviour support plans and staff being unaware of some people’s personal risks. We also found a breach of regulation 18 around staff not always receiving the training they needed to provide effective support and understand people’s specific conditions. Some staff were also unbale to explain how the principles of the Mental Capacity Act (MCA) impacted on the people that they worked with.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well-led to at least good. At this inspection we found that the provider had used the action plan to address these breaches. All staff had been re-trained in safeguarding, MCA and how to effectively use people’s behaviour support plans.

The problems found at the last inspection had been addressed and we found no further breaches at this inspection. The home is now rated ‘Good’.

Roseneath 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 home is registered to accommodate six people in self-contained flats. Each person has a large flat within the home consisting of a bedroom, living and kitchen area and a bathroom and contained everything the person needed to live independently. Since the last inspection the home had refurbished four of the self-contained flats to a high standard. The home also had a back garden that people had access to. At the time of the inspection, four people were living at Roseneath Avenue.

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.

There was 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 had person centred risk assessments that provided staff with detailed guidance on how to minimise known risks in the least restrictive way. Staff were able to explain people’s personal risks.

Behaviour that challenged was recognised and there were strategies in place tailored to each person. Staff understood how to work with people effectively to keep them safe and maintain their well-being.

Medicines were managed safely and people received their medicines on time. Staff had received training in medicines and how to administer them safely.

The home had a good understanding of infection control and staff used personal protective equipment to ensure safe care.

Staff received regular supervision, appraisal and training to support them in the role. Staff also received specialist training in working with people living with a learning disability.

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 supported this practice.

People were encouraged to eat healthily and the home supported people where they needed help with weight management.

People were observed to be settled and at ease with the staff supporting them. We observed friendly and kind interactions between people and staff throughout the inspection.

Relatives told us that they were able to visit whenever they wanted and were always welcomed at the home.

People, where possible, and relatives were involved in planning their care.

Care plans were detailed and provided enough information for staff to support people. Care plans were regularly reviewed and updated immediately if changes occurred.

The home recognised that stimulation and enjoyment were essential to people’s wellbeing. People were supported and encouraged to access the community and stay in contact with relatives and friends.

There was a complaints process in place and people and relatives knew how to make a complaint. Complaints were investigated and followed up.

Staff and relatives were positive about how the home was managed and how information was shared with them.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care. Where issues or concerns were identified, the manager used this as an opportunity for change to improve care for people.

Roseneath Avenue is a care home which is registered to provide personal care and accommodation for a maximum of six adults. People living in the home have autistic spectrum disorder. At this inspection there were three people living in the home in their own self-contained flats.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks had been identified and assessed that provided information on how to mitigate risks to keep people safe. However, one person had not been protected against identified risks to ensure they were safe at all times.

There was a comprehensive positive behaviour support (PBS) and traffic light plan for people who demonstrated behaviour which may put people and staff at risk. However, some staff we spoke with could not explain what PBS was or how they could use it to keep people safe.

Some staff were not able to tell us what constituted a safeguarding incident and who to report abuse to outside the organisation.

Mental Capacity Act 2005 (MCA) assessments had been carried out using the MCA principles by the registered manager. Deprivation of Liberty Safeguards application had been made to deprive people of their liberties lawfully. However, most staff were unable to tell us about the principles of the Act and what this meant for the people they supported.

Not all staff had completed essential training to perform their roles effectively such as MCA, safeguarding, first aid and infection control.

There were systems in place for quality assurance and monitoring. However, the quality assurance system had not identified the concerns we found with training and staff knowledge.

Medicines were being managed safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were given choices during meal times and their needs and preferences were taken into account. People’s diets were catered for. People’s weights were recorded and monitored regularly.

Care plans listed people’s support needs and were person centred.

There was a programme of activities. These activities took place regularly.

Complaints were recorded and investigated with a response sent to the complainant.

Pre-employment checks had been made to ensure suitable staff were employed by the home.

Appropriate referrals to other healthcare professionals were made.

People were treated in a respectful and dignified manner by staff.

Staff meetings were being held regularly.

Staff felt well supported by the management team and relatives were complimentary about the management of the home.

We identified breaches of regulations relating to training and safe care. You can see what action we have asked the provider to take at the back of the full version of this report.

Roseneath Avenue is a care home which is registered to provide personal care and accommodation for a maximum of six adults. People living in the home have autistic spectrum disorder. At this inspection there were six people living in the home in their own self-contained flats.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from abuse and avoidable harm. Staff knew how to report alleged abuse and were able to describe the different types of abuse. Two staff were unable to tell us they could ‘Whistleblow’ to external organisations such as the CQC and local authority. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service.

We found out of date food in three people’s flats. This meant that people may not be protected against the risk of food poisoning or other health complications. People were given choices during meal times and their needs and preferences were taken into account. People’s weight were recorded and monitored regularly.

Most risk assessments were updated to reflect people’s current needs and took into consideration people’s health needs. We found one person who was at risk of choking, there was no specific intervention or guidance to staff on the action that will need to be taken to ensure the risk of choking is minimised. The registered manager told us this will be included.

Systems were not in place to calculate staffing levels contingent with people’s dependency levels. We made a recommendation that staffing levels are regularly assessed by the service against people’s dependency needs.

We did not find evidence that people’s capacity had been assessed and if consent to care was obtained using the Mental Capacity Act 2005 principles.

Most staff had been trained. Although training had been provided in safeguarding and MCA, some staff were not aware on how to whistleblow and the principles of the MCA.

Due to risks to their safety people living at the home were not allowed to go outside without staff or relative accompanying them. Appropriate Deprivation of Liberty Safeguards had been applied for people that required supervision when going outside.

Some staff had concerns about the culture; however we saw the management team were taking appropriate action to address these concerns.

There was a positive behaviour support and traffic light plan for people that demonstrated behaviour which may put people and staff at risk. These plans provided information to staff on how to minimise the risk of behaviours that may challenge the service.

Care plans listed people’s support needs and were person centred.

Quality assurance had been implemented to allow the service to demonstrate effectively the safety and quality of the home.

Complaints were recorded and investigated with a response sent to the complainant.

Recruitment and selection procedures were in place. Checks had been undertaken to ensure staff were suitable for the role. Staff had received induction when starting employment.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made.

We observed caring and friendly interactions between management, staff and people who used the service. There was an activities programme in place and people participated in activities.

People were encouraged to be independent and their privacy and dignity was respected. People were able to go to their rooms and move freely around the home

Staff meeting were being held regularly.

We identified two breaches of regulations relating to consent and risk management. You can see what action we have asked the provider to take at the back of the full version of this report.

We spoke with one person who told us that they decided what they wanted to do each day, and that they took part in health and safety audits in the home.

Each person who used the service lived in their own self-contained flat at the premises. Two of the six people had two support workers with them throughout the day, and the other four each had one support worker. The staff who we spoke with said that they knew each person's needs well, and used the support plans and behaviour guidance for information on how to support each person.

The staff who we spoke with were aware of the nutritional needs of the people they supported, and of the signs of possible malnutrition.

The Registered Manager and staff were familiar with safeguarding procedures, including how to recognise and respond to signs of abuse. Safeguarding concerns were reported to the appropriate authorities, and appropriate actions were taken when needed following investigation.

The service had systems in place to help protect people from abuse.

Staff were supported to develop their skills and received training relevant to their role. Staff received supervision and new staff completed an induction.