Avenues South Hampshire Services

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of legal regulation in relation consent.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.
We found capacity assessments were not always completed when people first started using this service, and some assessments were only completed after the CQC inspection. This meant people’s individual needs were not always accurate and in line with their needs. Furthermore, there was no evidence to demonstrate people were involved in care planning, and that staff used individual communication techniques such as Makaton to ensure people’s involvement in these assessments was maximised.
 

The provider did not always plan and deliver people’s care and treatment with them. They did not always follow legislation and current evidence-based good practice and standards.
Where people had been prescribed or assessed as requiring specific treatment or care provision, the provider did not always demonstrate they delivered this. For example, we found 1 person was prescribed a toothpaste to be used twice a day as per the prescriber’s guidance. However, we found this was sometimes used up to three times a day. This administration was not in line with best practice standards, and it was therefore unclear how the provider was demonstrating the care and treatment provided was in line with best practice guidance.Following the assessment, the provider told us they introduced additional safeguards to ensure any changes made to people’s treatment were implemented without delay.
For another person, we found they required staff to support them to complete exercises to stand up, as part of their physiotherapy programme. Staff were to record how often the person was standing up as advised. However, we reviewed this person’s daily notes and found they were not supported to do this in a 4-month period. This meant people’s care and treatment were not delivered in line with their needs.

The provider did not always work well across teams and services to support people.
We received mixed feedback about staffing and teamwork. One staff member told us they felt there was a clique, and some staff were, “Pushed to one side if they were not loud.” Other staff told us, “Colleagues are supportive, I think we work well as a team.”
Relatives told us they were not always introduced to new staff. One relative told us, “We would like to meet new staff before they are employed. Sometimes the shift lead is not confident in their role.” Another relative told us, “There is no meeting [person] or me before they work.” This did not demonstrate the service always worked well with people and relatives to ensure provide continuity of care for people.

One partnership agency told us, “From my experience working with TheAvenuesTrust, they have very good working relationships with the GP services.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.
People had health action plans in place, and these were generally up to date. However, some people’s plans were not current and accurate. For example, 1 person’s plan stated the provider did not have access to the person’s height and weight, so this was incomplete. Another person’s plan failed to capture information for past or future healthcare appointments such as dentist, optician and chiropody. Although some people’s information about past of future appointments were not always captured in their health action plans; the provider showed us how they recorded this information on other systems.
Some people’s goals and aspirations were not demonstrated within their care records, and there was a lack of information to demonstrate these were regularly reviewed with people
 

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.
We reviewed 1 person’s diabetic care record for a 2-week period. We found the provider did not monitor their care and treatment, to ensure outcomes were consistent and in line with clinical expectations. For example, this person required their ketones to be monitored each time their glucose level reached or exceeded their safe range. However, we found at least 14 occasions when the ketone test was not completed following the glucose being raised above the safe range. We also found this person’s ketone test was not repeated after 2 hours on any occasion, despite this being an assessed need outlined in their care plan. This did not demonstrate the provider monitored people’s care to ensure safe and effective outcomes.
 

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.
Staff told us they administered 1 person’s medicines covertly because they would spit their medicine out. However, there was no documentation around best interest decision making for the covert administration of this medicine. Although this person’s medicine was later being crushed when administered, it was still unclear if the person was informed there was medicine in their food and drink.
We also found at least 3 people with cameras and monitors installed in their home. The provider failed to evidence best interest decision documentation at the time of our visit and confirmed for at least 2 people this was not in place. Staff we spoke with acknowledged this was a form of restrictive practice. The provider also could not demonstrate appropriate processes were followed to seek people’s consent regarding 1-2-1 support. This meant the provider did not consider and did not uphold people’s right. The provider failed to demonstrate they regularly reviewed this restrictive practice and took steps to reduce this restriction over time. Also, the provider did not demonstrate how people were supported to be involved in making these decisions.
Some relatives said staff did “not always” seek the person’s consent prior to any care and support being given.