Archived: Independent Options (Stockport) - 55a Beech Avenue

Beech Avenue provides a short breaks service to people (guests) who have a learning and/or physical disability. People supported by the service usually lived with a family member or shared lives carer. In this report we have referred to both relatives and shared lives carers as ‘carers’.

The property is a four bedroom detached dormer bungalow. There are three bedrooms on the ground floor and one bedroom on the first floor. The home has gardens to the front and rear and has two shared bathrooms and an additional shared toilet. The home is located within the residential area of Gatley, Stockport. The home is close to the motorway and Gatley train station is nearby. At the time of our visit there had been three guests who had stayed the previous night. There was no-one using the service present during the day at the time of our visit.

There was an acting manager in place who was in the process of completing their application to register with the Care Quality Commission (CQC. 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 identified breaches of six of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to assessing and reducing risk, the safe management of medicines, assessment and care planning, complaints, governance, training and supervision, and meeting the requirements of the Mental Capacity Act 2005 (MCA). We also made a recommendation in relation to reviewing guidance on the implementation of the MCA. We are currently considering our options in relation to enforcement in relation to some of these breaches of regulation, and will update the section at the end of this report once any enforcement action has concluded.

We found care plans had been completed to a variable standard. Some care plans contained only limited information on preferences and support needs, whilst others contained more detail. Care plans had not been regularly updated to ensure the information they contained was still accurate.

One person’s care plan did not detail clear information about the support the person required to eat and drink. This person was also at risk of choking and this risk had not been reflected in their risk assessment.

We received mixed feedback about activities provided at the service. Some carers reported people enjoyed the activities and were given a wide range of opportunities. However, we saw feedback had also been given to the provider requesting more trips out.

Some people enjoyed the service for the social aspect of meeting friends. It had not always been possible for the provider to arrange visits so that people could stay with friends who also used the service. The acting manager told us they were reviewing the booking process.

The person we spoke with using the service told us they received a choice of meal. Staff did the shopping on a weekly basis to meet the dietary requirements and preferences of guests booked to stay that week.

There were no clear instructions in place for staff to follow in relation to the administration of ‘when required’ (PRN) medicines. We also found one person who was prescribed a medicine for use in emergency situations did not have the required care plan in place to inform staff when they should administer this.

The provider had submitted applications to the local authority to deprive people of their liberty. It appeared a ‘blanket approach’ may have been taken to this without consideration of whether people were able to make their own choice about whether they stayed at the service.

We found evidence of the use of restrictive practices to keep a person safe. However, there was no evidence in the care plan that this had been considered as part of a best interests decision as is required under the MCA.

There was a small staff team and people who used the service regularly got to know the staff supporting them. Carers told us their family members felt comfortable with the staff supporting them.

Training was provided in a variety of topics. However, refresher training was overdue in some subject areas including epilepsy. One carer commented that staff did not seem to effectively identify when their family member had seizures. There were gaps in the provision of supervision to staff.

The provider sought feedback from people using the service and their carers. Questionnaires had been sent to people and carers and there were various groups and committees in place to ensure people, carers and staff had a say in the development and improvement of the service.

The service had investigated formal complaints. However, we found a concern raised by a relative had not been handled appropriately by a former manager and had not been investigated.

A range of audits and checks were completed by the manager and provider. These covered a wide range of areas. However, actions were not always completed in a timely manner and these systems had not been effective at ensuring the issues we identified had been addressed.

Staff felt motivated and valued in their roles. The acting manager also told us they felt the organisation was supportive of them. The acting manager had identified some of the areas where improvements were required prior to our visit and was taking actions to address these shortfalls.

We received positive feedback from a health professional with involvement in the service. They told us they found staff professional and said they had found the service provided to be excellent.

We spoke by telephone with three family members of the people who were staying at the home during our visit. We also looked at the care plans for two of the people who were present when we visited and were able to speak with them. They said that they liked visiting Beech Avenue. Everyone was relaxed and were enjoying the television programme Hollyoaks.

The family members said 'I have no worries at all and have no hesitation at leaving X at the home;' 'The new manager has made an appointment to visit me to introduce themselves'. Another person told us "X loves going to Beech Avenue they think the world of the place".

There had been three safeguarding investigations since our previous inspection in August 2012. Two were found to be unsubstantiated with the third investigation still on-going. As a result of these investigations systems had been improved to ensure that the most up to date care plans were at Beech Avenue and have been read by the support workers.

We visited 55a Beech Avenue which is one of two residential care homes that provide a short breaks service. Many of the people who use this service also use other services provided by Independent Options.

We spoke with the two support workers who were on duty at the time of our visit and two of the four people who were using the services of Beech Avenue. We also spoke with two family members by telephone.

The two people who used the service said that they liked going to Beech Avenue and that they liked the staff.

The family members we spoke with said; 'We would tell the service if we had any problems however we are very happy with the service and they are meeting X's needs'. 'X enjoys it at Beech Avenue, X loves it and though X is not able to talk X can make themself known as to what they want'. 'Everyone is really nice I am impressed with staff especially the senior support worker'. Both of the family members said that they felt their relative was kept safe.